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Community Affairs Legislation Committee
Australian Radiation Protection and Nuclear Safety Agency

Australian Radiation Protection and Nuclear Safety Agency


CHAIR: Welcome.

Senator LUDLAM: Welcome back, Dr Larsson. FSANZ have taken the meat curry away, so we have at least saved you that trauma.

Ms Halton : I am sure they will share it later.

Senator LUDLAM: Yes, everyone will get a little sample. What part does ARPANSA play in the regulation of irradiated food products in Australia?

Dr Larsson : ARPANSA plays a role in advising the relevant bodies on radiation levels and the safety of radiation levels. As an example, in the wake of the Fukushima accidents we have had a very fruitful collaboration with both FSANZ and AQIS. We have also, at the request of AQIS, performed a number of food-monitoring roles for a variety of food imports from Japan.

Senator LUDLAM: That is at a tangent to the question I am asking, but it is interesting nonetheless. That is for food that has been irradiated incidentally to the disaster?

Dr Larsson : This is not food that has been irradiated; this is food that might have been contaminated.

Senator LUDLAM: Have you had to stop or advise on the stoppage of any shipments?

Dr Larsson : No.

Senator LUDLAM: That is good news. What about food that has been irradiated deliberately and then imported into the country?

Dr Larsson : Food that is irradiated does not become radioactive. Irradiation is for sterilisation purposes and for control of biological hazards, but it does not become radioactive.

Senator LUDLAM: I am aware of that. Do you not play any part at all in advising—

Dr Larsson : No.

Senator LUDLAM: So that is entirely at the whim of the health authorities. What about the regulation of irradiation plants here in Australia? I am aware of two or three at least. Does that come into your domain?

Dr Larsson : Sorry—can you repeat that question?

Senator LUDLAM: Food irradiation plants that use sealed sources to blast fruits—

Dr Larsson : If they were to be Commonwealth entities, they would be regulated by us.

Senator LUDLAM: I believe they are not.

Dr Larsson : If they are not Commonwealth entities they would be regulated by the states and territories.

Senator LUDLAM: Got it. It does not sound like it is much of a part of your mandate. Could you provide us with a quick update on the status of integrating Northern Territory uranium miners into your National Radiation Dose Register?

Dr Larsson : I do not have any information from the Northern Territory at this point in time which would indicate when we would have access to the worker doses of the Northern Territory.

Senator LUDLAM: That is a shame. Have you written or has your minister written to the Northern Territory government?

Dr Larsson : I am not aware that my minister has actually written to the Northern Territory government. There has been an exchange of letters between the minister for resources—

Senator LUDLAM: I should put those questions to DRET, I guess, a little bit later in the week. To what extent has historical data been incorporated into the register thus far? If this is complex, I would invite you to just to table any summary information you have.

Dr Larsson : A very short summary is that we have six years of dose history for the Olympic Dam and we have, if I remember correctly, 10 years of dose history for the Beverley mine.

Senator LUDLAM: And nothing yet for Ranger or any of the mines that previously existed?

Dr Larsson : That is correct.

Senator LUDLAM: Are you chasing dose records from mines that operated and closed down in Queensland, for example?

Dr Larsson : We are not doing that currently. I think that, with the 18,200 workers that we now have dose records for, we need to actually have a little bit of a control over the performance of the dose register. I see that it actually performs the services that we set out to deliver.

Senator LUDLAM: If somebody spent a couple of years working at Ranger and then worked down at Roxby Downs, you have only got that fraction of the record that relates to their employment in South Australia?

Dr Larsson : That is correct.

Senator LUDLAM: I want to come to the question of the proposed Commonwealth radioactive waste dump. At some stage in the future ARPANSA will receive, we understand—it is government policy—an application to site a facility at Muckaty. Can you just detail for us how ARPANSA will address that application and, in particular, for the parts of the regulatory framework that relate to your domain—radiation safety, rather than the EPBC approvals—what will the framework for community consultation look like?

Dr Larsson : I think that is actually something that we need to discuss in detail when I see the application because it is, of course, dependent on the nature of the application, where the site is actually going to be identified, as to what system of management of the radioactive waste we are talking about here. Certainly there will be a process for public consultation and also for seeking input from all interested parties. I would not go into details right now as to how that is going to be set up. I can only say that that is going to happen.

Senator LUDLAM: So you have come some way along designing some kind of process; is that just on hold for the time being?

Dr Larsson : That is on hold for the time being and there has been no reason to progress that, considering that the bill has actually not progressed. As you may also understand, probably since March this year we have been very busy with other issues.

Senator LUDLAM: Yes, I will come to those—in fact, I will come to those now. The recent UN multiagency system-wide review of nuclear power post Fukushima mostly had lessons and recommendations relating to the operation of civil nuclear power plants. The issue of local impacts of uranium mining was addressed. Has ARPANSA provided or been asked to provide or formulated advice on possible mechanisms where Australia might comply with the recommendations that arose relating to uranium mining?

Dr Larsson : As you will know, uranium mining is something that is under state and territory control. There is a mechanism by which we can also influence the control over uranium mining, and that is through the national uniformity process through the Radiation Health Committee. Also, in situations where there is a licensing application, or an application that falls under the EPBC Act, we will also advise the department of the environment on radiation related issues. So those are, mainly, the points in time or the issues where we become involved.

Senator LUDLAM: In the specific case of that UN review, have you had the opportunity to see that and to examine the parts that are relevant to Australia?

Dr Larsson : I am aware of the UN review, but I cannot comment in any detail on that.

Senator LUDLAM: Could I draw your attention to the section around the local impacts of mining, where it is noted that concerns exist regarding the impact of mining fissionable material on local communities and ecosystems, and maybe I will pick these issues up when you are next at the table.

Dr Larsson : Thank you.

Senator LUDLAM: I will leave it there.

CHAIR: Thanks very much to the officers of ARPANSA. On that basis, we finish Population health, despite ourselves. We will go to lunch now. When we come back we will go into Acute care.

Proceedings suspended from 12:50 to 13:51

CHAIR: We are starting back with officers from outcome 13, acute care. My intention is to have this go through until about 2.35. My understanding is that Senator Fierravanti-Wells, Senator Adams, Senator Macdonald, Senator di Natali and Senator Furner all have expressed interest in asking questions. We will start with Senator Fierravanti-Wells.

Senator FIERRAVANTI-WELLS: I would like to start with some comments about elective surgery. Your annual report says that the states have exceeded targets for increasing the volume of elective surgery performed and the states have been rewarded for doing so. Is this on the basis of more people treated because more people presented or were there actual cuts in predetermined waiting lists?

Ms Flanagan : If you can give us a page reference, but I suspect this is referring to the 2008 Elective Surgery Waiting List Reduction Plan.

Senator FIERRAVANTI-WELLS: That is right. The increased funding was first announced in the 2008 budget. That was the $600 million that would be made available to clear elective surgery waiting lists and to provide an additional 4,000 procedures. And then another $803 million in the 2010-11 budget; is that right?

Ms Flanagan : So the new national partnership agreement, let me just give you the 2010-11 figure on that—

Senator FIERRAVANTI-WELLS: The point I am coming to, Ms Flanagan, is not so much where it was, but what the AMA has stated in its Public Hospital Report Card. Are you aware of that document?

Ms Flanagan : Not the details of it.

Senator FIERRAVANTI-WELLS: The AMA makes reference to this: 'that the so-called elective surgery "blitz" didn't really exist and that the government's own My Hospital website currently records that waiting times for elective surgery were up to 35 days in 2009-10'. In other words, the point goes to the verifiability of waiting lists and then the information in relation to the outcome of the elective surgery blitz and any criticism that the AMA or any other body may have had. I am really asking: how are these lists and how are these numbers verified?

Ms Flanagan : Under the 2008 agreement there is regular reporting against a series of indicators. We are interested both in volume—that is, the additional number of elective surgeries performed—and in looking at the average waiting numbers. I am looking at my colleagues as to whether they can give me the actual reading of that particular measure. We had always suspected that wait times could blow out, and I think they have gone up by about a day in terms of the average over the last couple of years, and that can be due to a number of factors. For example, if you do a lot of your short waits or your long waits, it is going to change the average. We are looking at a range of indicators, and certainly the ones you have mentioned around volumes have increased and we believe have exceeded what was required under that agreement.

Senator FIERRAVANTI-WELLS: Are those published or are they available?

Ms Flanagan : I believe that they are, yes.

Senator FIERRAVANTI-WELLS: Last time I was given an extract from some document, which I should have known about but did not, so there is obviously a document—one of your little handbooks, Mr Thomann.

Mr Thomann : We have Australian Hospital Statistics, which is a regular publication from the Australian Institute of Health and Welfare, that has a range of statistics about hospital performance. In terms of waiting time statistics, one of the indicators they measure are days waited at the 50th percentile, that is the median waiting time. In 2007-08, 34 days was the median waiting time; in 2008-09 it was 34 days again; and in 2009-10 it was 35 days. So it is not a dramatic shift.

Senator FIERRAVANTI-WELLS: But the methodology of that, Ms Flanagan, where is that methodology for weighing up that formula?

Ms Flanagan : I believe it is specified in the 2008 agreement and I think we were not only measuring at the 50th but also measuring at the 90th percentile to see what was happening to long wait times, for example. There were five or six indicators that I think we report on.

Mr Thomann : Yes, there are other indicators such as days waited at the 90th percentile. Those statistics are: in 2007-08 it was 235 days; in 2008-09 it went down to 220 days; and then in 2009-10 it was back up to 246 days.

Senator FIERRAVANTI-WELLS: How does that then measure up against media reports—I have any number of them—that talk about waiting lists, such as the Courier-Mail reporting in June that 'hospitals were turning urgent need patients away as waiting lists continue to climb', the Sunday Telegraph in May talking about 'secret waiting lists', and various other media reports. You have seen them from time to time. How does that weigh up against those reports?

Mr Thomann : The institute's collection is a national collection of data, which goes through a rigorous process against defined data items that are reported from each state and territory health department. They also go through a verification process, I understand. So those are national statistics which are showing the national picture. I suppose what is more newsworthy is those anecdotal examples of particular areas of the health system in particular hospitals where there may be pressures.

Senator FIERRAVANTI-WELLS: These copies have markings on them, but I will provide them to you. But this is the flavour of them: for example, the Courier-Mail on 11 June quotes Queensland Health Minister Mr Wilson and it says:

... a quick check had uncovered at least 300 were turned away. Mr Wilson yesterday said a quick check had uncovered at least 300 more patients who were turned away from Gold Coast hospitals in the past year.

I will provide these to you but if you could comment in relation to this because there seems to be a discrepancy on the one hand between the data and these media reports. As Ms Halton said, one does read things in the paper but these comments—and I would otherwise not be raising it—are quoting the Queensland Health Minister and that is why I would like you to comment formally on them.

Mr Thomann : All I can say is that the states are the managers of the hospital system. They are expected to respond where there are pressures in certain parts and to allocate resources through their planning processes accordingly across the state. If there are pressures on the Gold Coast, there would be an expectation within their overall state budgeting and allocation of resources between hospitals to get some balance in the system.

Ms Flanagan : I do not wish to denigrate too much the Courier-Mail and other publications but I suppose—

Senator Furner interjecting

Senator FIERRAVANTI-WELLS: Senator Furner has a particular interest in Queensland, as does Senator Macdonald.

Senator IAN MACDONALD: He should be very happy with the Courier-Mail. I am surprised to hear you say that, Senator Furner.

Ms Flanagan : Moving on from that authoritative source, we need to look at a national picture on the data that we are being supplied by the states and territories. Page 318 of the annual report shows that the 2010-11 target for the number of elective surgery procedures expected to be undertaken across the country was set at 624,813 and that the actual was higher than that at 659,685. Again, the percentage increase that we were expecting was 3.4 per cent and the actual was 5.2 per cent. This is the data that we are collecting to show that overall targets have been exceeded in terms of the number of elective surgery procedures performed in the country.

Senator FIERRAVANTI-WELLS: Given the time, Ms Flanagan, I will put a few more questions on that on notice. Moving on to my next item: the annual report says that you cannot provide any information on performance in emergency departments until next year. But given the minister's announcement in a media release on 12 May 2009 that $750 million was budgeted in the 2009-10 budget to reduce pressures in emergency, what was the result of this funding allocation? Given that the moneys were in 2009-10 but you cannot get performance data until next year, how are we going to look at whether these funds were properly used and properly allocated?

Ms Flanagan : That particular agreement and that sum of money was in effect not tied to performance. There are areas where funding is provided to states and territories but we do not have that very close correlation with targets. The four-hour access target in this new national partnership agreement is going to be measured so we will be able to report on the success of that. So when the states were provided this money we had not required the states to actually start measuring what was happening with emergency department access.

Senator FIERRAVANTI-WELLS: So in the end it is not tied to performance, so how do you know if that extra funding is actually producing the results that you wanted to produce? Obviously you read the sort of reports that I have referred Mr Thomann to—yes, they were not just in the Courier-Mail but in other newspapers around the countryside. What is your guarantee that this is actually happening on the ground?

Ms Flanagan : One of the things we have measured—and part of this is that different agreements require different things. I know how difficult that can be for you, and we do not find it easy sometimes either but—

Senator FIERRAVANTI-WELLS: Your resources are considerably greater than mine, Ms Flanagan.

Ms Flanagan : One of the things we have measured in the past around emergency department access is the wait times to be seen. The measure we are now using is a very different one from that—

Senator FIERRAVANTI-WELLS: Is this a standard measure, not like 'beds'—

Ms Flanagan : It is a standard measure.

Senator FIERRAVANTI-WELLS: And the definition of 'bed'. I was going to come to the definition of 'bed' and whether we have progressed on that.

Ms Flanagan : No, we have not progressed; we can just be even clearer about how you might define a bed or a bed equivalent.

Senator FIERRAVANTI-WELLS: We will come to that in a moment.

Ms Flanagan : That was a discussion we had last year. Under previous healthcare agreements we have collected overall, in effect, wait times to be seen in emergency departments. I think those figures continue to be collected and reported. At a high level, we are certainly monitoring what has been happening under that sort of measure. I do not know when we last reported on the emergency department measures.

Mr Thomann : For this NPA it is an annual report. The states are required to provide us with an annual report with respect to that first $750 million.

Senator FIERRAVANTI-WELLS: I want to turn to two specific comments. You may be aware that after the New South Wales election there were reports in the Sunday Telegraph quoting the new—

Ms Flanagan : Another eminent paper, Senator.

Senator FIERRAVANTI-WELLS: Yes. If you are in New South Wales, it does often carry some very interesting news items, one of which included comments by the new minister talking about secret 'waiting to wait' lists for elective surgery which had been disclosed to the new health minister. Were you aware of that? Have you taken that up in some form or spoken to the new minister in relation to that?

Ms Flanagan : I think there have been some stories about the wait list to get on the wait list. One of the things that the expert panel was very exercised about was exactly this issue. Professor Baggoley and his esteemed colleagues recognised this as an issue. One of the recommendations was to commission work on trying a slightly different measure which would be to measure from point of first referral. Professor Baggoley might be able to explain it better than I can. We do not have the data all the way to measure this. It is something that we would need to develop in conjunction with the states and territories.

Senator FIERRAVANTI-WELLS: Is that part of the redefinition of waiting and the new waiting time definition?

Prof. Baggoley : Thank you for the opportunity. The expert panel, of which I was chair, which included two surgeons and Associate Professor Brian Owler, a neurosurgeon from Westmead, and Dr Michael Grigg from Melbourne, looked at the whole issue of elective surgery, as we were required to do. What we noted were the current inconsistencies in the application of elective surgery targets, not just between hospitals or specialties but between states. Our recommendation 10 of the report was that, as a matter of urgency, national definitions for elective surgery categories be further developed, agreed and implemented across all states and territories. We also recommended that a nationally consistent definition of 'not ready for care' be developed and applied, and, while new definitions were under development, there be more detailed guidelines to be developed and applied across existing urgency categories to ensure, as much as possible, that there would be consistency in measurement and data collection. We recognised that sometimes people had to wait to get an outpatient to a clinic appointment, and then to get onto surgery there were examples where people had to wait to get on the waiting list, and then they may be deemed not ready for care. So there was a whole range of ways that made it very difficult to compare between specialties, hospitals and states as to what was happening. For the patient, of course, this was just a total mystery.

Senator FIERRAVANTI-WELLS: Bureaucrats were to be creative in their descriptions, Professor.

Prof. Baggoley : It could be that or, God forbid, even for clinicians to be so creative. What we learnt from the United Kingdom is that they had taken a measure from when a general practitioner first referred a patient for care to the hospital to when they had that care. That was the time. That is why the recommendation that we came up with, which is recommendation 14, was that there be a measure of surgical access time. Forget all the little steps in the way—just from the time of referral by the GP to when you have your procedure. That is the time. In the United Kingdom, 18 weeks is the target they had, and they have done very well with that. We believe that such a measure should be developed as would determine the true waiting time and the true demand for elective surgery. We believe that consideration should be given to utilising such a measure of elective surgery performance in future agreements. That is for the future, but we recognise that.

Senator FIERRAVANTI-WELLS: When is it anticipated that we will have a clear definition on this, Professor? It is clear, given the various things that are happening at a national level and payments that are being made for a whole range of things, whether they be with or without performance measures attached to them, that it is necessary.

Prof. Baggoley : There are two aspects to this. One is to move as quickly as possible to get national consistency for the current agreement. The panel recommended, as I said, that that happen as a matter of urgency, and that process then is something for all the states, territories and the Commonwealth to agree on. This is a five-year agreement. For the next agreement, when it comes up in five years time, the panel recommends—and I am speaking on behalf of the panel, not the Commonwealth—that the simpler definition be embedded and ready to go.

Senator FIERRAVANTI-WELLS: So we are going to wait five years. Or are we going to implement a definition sooner?

Ms Flanagan : For the purposes of the agreement that was signed now, we have a definition embodied in that agreement that we need to measure against which is not—

Senator FIERRAVANTI-WELLS: But the professor is talking about a better definition—

Ms Flanagan : This will arguably be a better definition. This particular recommendation has been referred to one of the subcommittees of health ministers and health CEOs to start work on. Until we get into the work, we are not going to know how long it might take to develop it, but the work has been referred to one of the principal committees.

Senator FIERRAVANTI-WELLS: Given the provisions in the agreement for variation, is it possible that there could be a variation to the agreement on this or indeed any other specific term of the agreement or definition?

Ms Flanagan : There could arguably be, but it really changes the platform on which this agreement was set, because if you have—

Senator FIERRAVANTI-WELLS: Of the funding.

Ms Flanagan : Yes, of the funding. Also, you are involving parts of the system that in effect are not necessarily under state control, and this is an agreement between the states and the Commonwealth.

Senator FIERRAVANTI-WELLS: I will pursue that in questions on notice. I now turn to two states in particular. The first is Tasmania. Some issues have appeared in the press in relation to Tasmania. There have been reports that Tasmania has cut $500 million from its health expenditure in the 2011-12 budget across its forward estimates, and, of course, the reaction around the state in relation to that has also been reported. There are estimates about jobs—150 has been quoted—and wards and beds are likely to close at Royal Hobart Hospital and also at Launceston General Hospital. They are both predicated to lose beds. Without taking you specifically to them, Ms Flanagan, you are aware of those media reports?

Ms Flanagan : I certainly am, Senator.

Senator FIERRAVANTI-WELLS: The Prime Minister had promised that under this new agreement we would have more beds, more money, more services, more local control and less waiting times. How does this explain what is happening in Tasmania? Given that the agreement calls for maintenance of effort by the states in clause A80, how does Tasmania qualify for continued federal funding or for reward funding?

Ms Flanagan : Specifically under the national partnership agreement you would understand of course that states are the majority funders of the hospital system at the moment. We are moving into new arrangements into the future. In terms of the national partnership agreement itself, states and territories have committed to targets on elective surgery and emergency departments. One would suspect that if you are closing beds in Tasmania—and that is a state government decision—it may be more difficult to deliver on those targets and that, if Tasmania were not to deliver on those targets, it would not get any reward funding, because that is the way this particular national partnership agreement is structured: around the fact that you need to achieve certain things in order to receive reward funding.

Senator FIERRAVANTI-WELLS: At the beginning of your answer you said that you are obviously keeping a keen eye on what is happening Tasmania. At what point will you make that assessment as to whether Tasmania will lose federal funding?

Ms Flanagan : I do not know that it is a question of losing federal funding.

Senator FIERRAVANTI-WELLS: Whether Tasmania will lose federal funding.

Ms Flanagan : That is a decision that government will need to make into the future. These agreements were signed, I think, on 2 August. We are six weeks into it. The national partnership agreement for Tasmania runs for four or five years. They might be having trouble now but do you say six weeks into the agreement that they are not going to deliver overall on the targets? The targets are set for the end period and it is possible for states and territories to set their own profile of targets to achieve that ultimate target over the course of the agreement.

Senator FIERRAVANTI-WELLS: So the calculations are based on the end period, and at the end of the period they—

Ms Flanagan : Ultimately, we are looking to achieve that at the end of the period, though there are milestones that are set during that. I think there is a capacity to roll over funding if they do not need to target in a particular year, so that if they are able to achieve the target the following year they will be able to receive their reward funding.

Senator FIERRAVANTI-WELLS: The Prime Minister has made a commitment that there would be more services and less waiting time.

Ms Flanagan : And we would hope that that will be what we achieve.

Senator FIERRAVANTI-WELLS: But that is not her commitment. It could have been her hope, but she cannot give that commitment in those terms because it is out of her hands—it is up to the states.

Ms Flanagan : She can certainly give the commitment in terms of what the Commonwealth has signed up to deliver.

Senator FIERRAVANTI-WELLS: If I read correctly, she said on 3 August: 'More money, more beds, more services, more local control, greater accountability, less waste and less waiting time.' How can you give a commitment for all that when you have to wait five years to see if the states meet their side of the bargain? It is a hollow commitment. It is meaningless.

CHAIR: Is there question there, Senator?

Senator FIERRAVANTI-WELLS: It is a 'commitment' but its validity can only be measured in five years time. Is that a correct assessment?

Ms Flanagan : I think that that would be correct, certainly in terms of this national partnership agreement.

Ms Halton : Mind you, Senator—

Mr Thomann : Sorry, Senator—

Ms Halton : You go first.

Mr Thomann : May I, Secretary?

Senator FIERRAVANTI-WELLS: You can interrupt first, Mr Thomann. Ms Halton has given you that privilege.

Mr Thomann : I do not make it a habit to interrupt the secretary, but on this occasion I feel as though I must speak.

Ms Halton : He is mostly a wise man.

Senator FIERRAVANTI-WELLS: Ah, you have your trusty little book.

Ms Halton : He has his trusty little book.

Mr Thomann : I have my trusted book and I actually have copies from last time. We have copies for the whole committee.

Senator FIERRAVANTI-WELLS: You only gave me an extract the last time. This time you actually have a book for me.

Mr Thomann : I feel that we should speak on an equal basis. We will table these little handy copies of the new agreement for you and the rest of the committee members as well.

Senator FIERRAVANTI-WELLS: You will be very pleased to know that—

Ms Halton : This is a much handier, wallet-size.

Mr Thomann : We have interim targets for both elective surgery and emergency department targets.

Senator FIERRAVANTI-WELLS: Which page are you on?

Mr Thomann : We are talking about elective surgery. We are in schedule A. You will find on page 20 of the little booklet, we have interim targets for both categories 1, 2 and 3. There is a differential in terms of the final target to be achieved, with Tasmania, the ACT and Northern Territory to achieve the final target of 100 per cent in 2016 and with the other states to achieve that target in 2015. But there is a regime for regular monitoring of progress.

Senator FIERRAVANTI-WELLS: You will obviously monitor. This goes back to the previous question. At what point will the Commonwealth realise that this is happening and it is happening now? Ms Flanagan, when is that assessments made?

Ms Flanagan : As Mr Thomann has indicated, there are yearly targets that we will monitor against and reward funding is tied to those. There will be yearly monitoring of what is going on. However, the principle is that this agreement is structured in such a way that, at the end of the period, if the states and territories hit their targets, then I would say that this has been a successful national partnership agreement.

Senator FIERRAVANTI-WELLS: I note the comments made by the Premier of Tasmania that she is happier for a federal takeover. Is that something that has been warmly welcomed?

Ms Halton : I do not know that we are aware of how it has been welcomed by others. I think it has been observed.

Senator FIERRAVANTI-WELLS: I will close off on Tasmania. In the end, we were promised that this brave new world of health reform would stop the blame game, but aren't we really seeing in these sorts of comments—I suppose this is more a comment to Senator McLucas—that the blame game has not changed at all. We will watch with interest just to see what happens in Tasmania. Just briefly, in relation to Queensland, again there were media reports of blowouts in Queensland's health budget. Has the Queensland government flagged problems with its health budget with the Commonwealth? Have there been discussions between the Commonwealth and Queensland about possible bed closures in that state?

Ms Flanagan : On Queensland, we have had no discussions.

Senator FIERRAVANTI-WELLS: Other than what you read in that distinguished daily rag—

Ms Halton : That paper of repute—yes, that one.

Senator FIERRAVANTI-WELLS: you do not have any other comment?

Ms Halton : No.

Senator FIERRAVANTI-WELLS: I will put some questions on notice in relation to countries and some assertions, again in that worthy publication, about us not being able to meet our international obligations under agreements, because patients are being turned away from hospitals. I will put questions on notice in relation to what may be happening. That was an article on 3 October. I will ask some questions about that specifically. In relation to local hospital networks, are we going to get some maps?

Ms Halton : In due course. We perhaps have some maps, but we do not have a complete set.

Mr Thomann : We do not have a complete set, but I believe on the yourHealth website you will find maps of LHN boundaries for all states and territories, except Western Australia and Victoria at this stage.

Senator FIERRAVANTI-WELLS: I go back and look at the progress and delivery reports—and I had a look at that on page 12—about the local hospital networks. There was the initial promise in the blue book. I know, Ms Flanagan, but I do go back to these things. That is what was promised in the beginning. On page 60 of that book it says:

... to run small groups of hospitals, so that hospitals better respond to the needs of their local community.

When I look at the provisions of D5 and D15 in the latest agreement, to August, they are a far cry from what was originally envisaged about local hospital networks, aren't they? It has evolved to a totally different entity. I hold up page 62 of the blue book. There is a hospital and all the little hospitals around it. I know, Ms Halton, it is hard to go back to that many iterations ago.

Ms Halton : No, it is more that my eyesight is such that I am squinting at you to see what you are pointing to.

Senator FIERRAVANTI-WELLS: I am sure there is still a copy of a blue book floating around the department somewhere.

Ms Halton : I am sure there is.

Senator FIERRAVANTI-WELLS: We can you look at the provisions of D5 and at the parameters of their responsibilities. If you look at my favourite clause of D16, it appears to have survived almost intact from the previous version which was A10(b) i-v—remember my famous local isn't local clause—where it says that the clinical expertise will be external to the local hospital network wherever practicable. I notice that that has survived despite all of the discussions that have happened. Can I have an explanation as to why that clause is still there, despite everything that has been said about 'local not being local' and the clinical expertise coming from that local area? Is it because it was always the intention that the clinical expertise for local hospital networks would always come from outside the local hospital network? It just simply reinforces the criticism that local will not be local.

Ms Halton : We have canvassed this rather at length in the past, and you will recall that these words are the same for precisely the reasons we discussed last time. It says 'wherever practicable'. The truth of the matter is that it may be the case that in a number of instances it is not practicable, based on agreements. You know that the Victorian government has one particular view, and the AMA, as I understand it, had discussed that with the Victorian government. The objective here is to make sure that if there are conflicts of interest or perceived conflicts of interest then they are managed. Therefore, the language 'where practicable' has remained. In fact, I can tell you that this has not been a major issue of discussion for as long as I can remember. This is not in the area of contest; it is actually quite well accepted.

Senator FIERRAVANTI-WELLS: The reason I am going back to this is that you ran an advertising campaign that talked about 'run local'. In that whole 'run local' campaign, where is the 'run local'? There is nothing in this agreement and there was nothing in the previous agreement that looked at running local. Indeed, if you look at D5, you see there is nothing here about being locally run. They are not running anything.

Ms Halton : We may just have a different view of the meaning of these words in D5. I actually think D5 is exactly that. It is about local hospital networks. We know that some people in New South Wales, for example, are using the word 'district'. That is immaterial; the structures are there and they do have a responsibility to manage the budget that they have. This clause includes local governance arrangements, it includes receiving the funding that is provided and it includes managing performance of functions and activities specified in service agreements. I know from discussions that I have had with individual members of a number of these boards that they believe they are taking on the responsibilities to deliver local services. I had one of these discussions as recently as 24-hours ago.

Senator FIERRAVANTI-WELLS: I will put the rest of my questions on notice. In terms of determining the parameters of those local hospital networks, I was recently in South Australia and the 'local hospital network'—and I put that in inverted commas—covers virtually the whole state. How is that going to be an effective delivery of any responsibility?

Ms Halton : There are two things about this, isn't there? The first of which is—and we had that slight joke about doctors not wanting to be called bureaucrats earlier on; I think the Professor was party to that—

Senator IAN MACDONALD: Can we leave the jokes out? We really are pressed for time.

Ms Halton : No, no, this is actually not a joke, Senator—

CHAIR: Senator MacDonald, we do not need your contribution in that way; we are moving through this.

Ms Halton : This is not a joke. The whole point about this is that bureaucrats were the people who people did not want to see actually running local services. The whole point about this is to have people who have business expertise and expertise in running and delivering things actually doing that work. So this is actually not a joke, Senator. The reality is, if you look at the people that have been appointed to a number of these boards—including for example, in New South Wales—you are hard pressed to find a bureaucrat amongst them. But they do have operational experience in delivering high-value activities. In terms of the scale of them, they have to have a scale which is meaningful. Because at the end of the day—

Senator FIERRAVANTI-WELLS: The whole state or virtually the whole state? How can that be meaningful?

Ms Halton : They have to have a scale which goes to economies of scale. If we look at the experience that we had in the past of boards, very often the problem they had was that they were too small. They did not have people who had expertise and experience in the management of large complex agencies. That is what these are; these are large businesses. In many cases, they have extremely large budgets—tens of millions of dollars. There are not trivial things to run.

Senator FIERRAVANTI-WELLS: I will leave it there. I will put the rest of my questions in this section on notice.

Senator IAN MACDONALD: I only have five minutes, and Senator Adams has five minutes—

CHAIR: And then Senator Furner, if I can just extend it, has five minutes as well.

Senator IAN MACDONALD: Okay. That is fine. Can I ask for very brief answers. I would hope someone is aware of this, because I did write to the minister a couple of weeks ago. These questions are related to that, although they are not exactly the same issue. Can someone give me a three-line description of what the COAG 19(2) exemptions are and how they work?

Mr Thomann : The section 19(2) exemption from the Health Assurance Act enables hospitals in rural and regional community—

Ms Halton : Where the exemption is given—

Senator IAN MACDONALD: Look, can you tell me if this wrong on 19(2): in selected areas where it applies, if people come into a general hospital then the hospital can get Medicare payments.

Ms Halton : You can bill Medicare. The 19(2) exemption enables you to bill Medicare.

Senator IAN MACDONALD: Yes, thank you. When the Medicare payments come though, they go to in this case Queensland Health. Is Queensland Health then obliged under the arrangements to pay them to the hospital involved?

Mr Maskell-Knight : I think legally the payments are due to the patient who then assigns them to the medical practitioner. The medical practitioner may then have an employment agreement whereby they are passed through to someone else.

Senator IAN MACDONALD: They belong to the patient? I assume the hospital—

Mr Maskell-Knight : Medicare benefits are personal benefits.

Senator IAN MACDONALD: I would assume the patient, when they go to the hospital, would sign a form saying this is a—

Mr Maskell-Knight : They assign their right to the benefit to someone else.

Senator IAN MACDONALD: Fine. It should go to the patient or where the patient directs?

Mr Maskell-Knight : Yes.

Senator IAN MACDONALD: That is excellent. If those funds are not allocated in one financial year, they roll over into another financial year?

Mr Maskell-Knight : I think you are going to a matter of the Queensland health department's accounting practices. We have no visibility of those.

Senator IAN MACDONALD: What I am just getting at is that Mareeba hospital, which I have written about, has what they believe to be all of this money due and owing to them, and as a result of that they have extended their services, because they are in an area where there are less than the optimum or the necessary number of GPs. Mareeba hospital has then spent, in anticipation, the money to employ other health services in an area that is underserved. But they find that the money is not coming through to them from Queensland. There is something like $800,000 owing to them, so they tell me, give or take a few thousand. I guess your answer to the first question says it all. The money actually belongs to the patient or where the patient directs, so it is legally Mareeba hospital's money.

Mr Maskell-Knight : Not necessarily.

Ms Halton : No, not necessarily. That is not how it works. The reality is that if there is an agreement that is struck by medical practitioners with the Queensland department of health that they will bill then the Queensland department of health, if that is their employer, can actually direct where those funds go. In other words, it is not a question of the hospital; it is a question of what the arrangements are in that particular location as to where those funds are actually paid.

Senator IAN MACDONALD: What is the Commonwealth Medicare arrangement? Does the money go to where the patient directs?

Ms Halton : If the patient is going to be treated, they would have signed a form—it will be a standard form—and that form will basically say to whom the money should be remitted.

Senator IAN MACDONALD: And that would be to the doctor or to the hospital or to doctor's employer?

Ms Halton : It will depend on the arrangement in that particular state. This happens in New South Wales and it happens in a number of states?

Senator IAN MACDONALD: What happens in Queensland?

Ms Halton : I do not think we can answer that question on the spot; we will have to check.

Senator IAN MACDONALD: Please could you take on notice that series of questions that I have raised and tell me what happens in Queensland? What happens in the case of Mareeba hospital? Is it a fact that money is owed by Queensland Health to Mareeba Hospital—or whatever the situation is? I wrote to the minister about it a couple of weeks ago. If you could incorporate—

Mr Thomann : We are aware of the issue. We have raised it with Queensland Health and they have undertaken to talk to the Mareeba Hospital about this matter.

Senator IAN MACDONALD: Thanks for that. But Mareeba Hospital really do not want talk; they want that money, if they are entitled to it under the COAG agreement, which is administered from here by the Commonwealth. Well, Medicare payments are Commonwealth and they come through COAG. I can only act on what the Commonwealth can or cannot do. That is why I am asking how I can ensure that the people in the Northern Atherton Tableland get these additional services Mareeba Hospital wisely and credibly engaged because they thought they had the money coming in.

Mr Thomann : We will take it on notice.

Senator ADAMS: I have questions on the local network boards and their boundaries. I am from Western Australia and I am just having a looking at the regional health service boundaries plus the network board boundaries plus the Medicare Local boundaries. Unfortunately, none of them run the same way in the same areas. So I am quite confused about that and I would like an explanation as to how it is all going to work practically.

Ms Flanagan : Certainly one of the principles that we started with was that we wanted to see some alignment between the Medicare Local boundaries and the LHN boundaries. You would appreciate that the Medicare Local boundaries are determined by the Commonwealth and we put those out to the states and territories and consulted on those. I do not know whether we have anyone here from the area that looks after Medicare Locals. Local hospital networks were determined by the states themselves.

Senator ADAMS: I realise that.

Ms Flanagan : We had hoped for alignment. I do not know whether my colleagues know how misaligned Western Australia's are, but I thought they were fairly closely aligned.

Mr Thomann : I am not aware of how they are aligned.

Senator ADAMS: It is quite a concern. Having been involved with boards for a long time myself, I just cannot see how the practical issue is going to work. I thought there might have been a reason, but I will follow that up again with WA Health.

I may need some help here with performance authorities and how the authorities work together on medical errors. Does that come within this particular area?

Ms Halton : We have the safety and quality commission and, as you know, they do already report in terms of quality and safety, including misadventure, and then we will have the performance authority that will have an overarching view. There will have to be a discussion between the two. I would imagine that the safety and quality commission will continue to publish in these areas, but the performance authority will have a much broader remit in terms of how the whole health system is performing.

Senator ADAMS: Will there be any duplication between the two?

Ms Halton : There will not be any duplication. There may be dual publications of some of the data. I cannot say that will not happen. It might, in fact, be quite desirable for information to be collected once but maybe sometimes disseminated through a number of different sources, but there will not be duplication of the work—if that makes sense.

Senator ADAMS: Thank you. I will watch that. Reporting the regulatory burden versus patient care seems to be quite a problem. As we are moving on with health, with Medicare Locals and acute hospitals, there seem to be multiple reporting requirements on top of existing reporting requirements. It is felt that it is taking the focus away from patient care. Has the government ever undertaken any analysis or research on what the costs of this regulatory burden is on the provision of patient care? It happens in aged care a lot, but it is now happening in acute care too.

Ms Flanagan : I will start by indicating that one of the things that the states and territories have been discussing with the Commonwealth is, I suppose, the reporting issues, in terms of wanting increased transparency about what goes on in Australia's hospitals in particular. There has been a working group set up to look at data rationalisation. Going back to the secretary's point around the Commission on Safety and Quality in Health Care, the Health Performance Authority et cetera, that you should just collect one piece of information once—it might be reported in a number of different ways—there is certainly an interest in ensuring that, as we move into this new era of transparency, the reporting burden does not increase and that we actually rationalise what we are asking the states and territories to do. The particular group that has been set up I think reports to health ministers in November about what they have found and how the data reporting burden can be rationalised. There is also work being undertaken by treasuries in terms of the National Health Performance Framework. That will also come to fruition and we will get a report back on that very soon. That covers not just health but the whole spectrum, such as education et cetera.

Senator FURNER: Thank you for the booklet. I think it answers my first question and that was in relation to the numbers of beds that will be allocated as a result of the health reforms. It indicates that, overall, by the end of 2014, there will be 1,316 in total amongst the states and territories. I take it that we are talking about financial years in the table?

Mr Thomann : Yes, they are financial years in that table, E14.

Senator FURNER: What improvements will happen in particular in one of the fastest-growing areas in the state, in Logan, with respect to Logan Hospital, as a result of the health reforms?

Mr Thomann : That is a very specific question. I might ask Ms Smith to answer that. We have a wealth of information resulting from the implementation plans from the different states and territories. It is just a question of finding that information.

Ms A Smith : Under the current NPA on improving public hospital services, Logan Hospital has been identified for a number of projects. One project is for approximately $52 million. That is for expansion of the emergency department in conjunction with capital improvements throughout the emergency department, to help implement the four-hour rule. Logan Hospital is also, in the same project, referred for approximately $25 million. It is for 14 additional paediatric inpatient beds. It is also about having to revise the car park. Because of the way the hospital is structured they needed to revise the car park as well. Logan Hospital also has another project that will deliver a 24-bed rehabilitation ward, delivering some subacute services in that facility as well.

Senator FURNER: Thank you for that.

CHAIR: That is the end of the acute care questions. Thank you very much. Senators have said that they will put their questions for General Practice Education and Training on notice. I do apologise, but I just checked with the senators and that was their preference. We move on to 5.1: primary care education and training.

Senator FIERRAVANTI-WELLS: My questions in this area are the ones that were deferred earlier on. I have questions on Medicare Locals, GP superclinics and, if we have time, primary care practice incentives—otherwise they can be put on notice, and I am happy to put on notice questions in relation to the agency. In relation to the first 19 Medicare Locals funded from 1 July, how many were actually established by 1 July?

Mr Butt : By 1 July all 19 were funded. They had funding agreements in place for all 19 for transition funding for them to go through the processes and procedures to become fully established.

Senator FIERRAVANTI-WELLS: So they are not fully operative?

Mr Butt : They are all fully operative.

Senator FIERRAVANTI-WELLS: So the timeframe will still be the same for the establishment of the rest of them?

Mr Butt : Yes, there are 43 to go. There were 48 applications for those 43. The assessment process has been underway. We are looking for an announcement before too long—looking for around 15 to be established from 1 January and the remainder by 1 July next year.

Senator FIERRAVANTI-WELLS: And as part of that process you have sent stakeholders the detailed information about roles and responsibilities?

Mr Butt : Absolutely, yes.

Senator FIERRAVANTI-WELLS: I think that has been tendered in the past.

Mr Butt : I think it was 19 July that the applications closed for those.

Senator FIERRAVANTI-WELLS: But is the material that you are sending out publically available?

Mr Butt : Yes it is, and that was first published I think on 22 February.

Senator FIERRAVANTI-WELLS: In terms of bureaucracy and the bureaucratic neutrality that we were discussing earlier, is that commitment in relation to Medicare Locals still the case? There is a reason I ask—when did you, the government or the department realise that you needed a new national body, a new bureaucracy to oversee the function of Medicare Locals?

Mr Butt : I think those working in Medicare Locals would take the suggestion that they are a bureaucracy with some difficulty given that these are private companies that are established under the Corporations Act and so they are not public sector organisations. They basically are evolving from and replacing the divisions of general practice. The divisions of general practice were also private organisations, and we are going from 111 divisions down to 62 Medicare Locals. So, firstly, they are not government bureaucracies and, secondly, there are fewer of them then there are divisions.

Senator FIERRAVANTI-WELLS: Well interestingly I note that on 28 June the General Practice Network announced that its CEO would resign to become deputy secretary, which is yourself.

Mr Butt : That is me, yes.

Ms Halton : So he may have a conflict of interest here depending on where these questions are going!

Senator FIERRAVANTI-WELLS: Yes, I know! Tell me, you were in private practice and you have now become a bureaucrat. Do you not think that that is a conflict of interest? You do not see any potential conflict of interest in your current position having gone from where you were to what you are doing now?

Ms Halton : I actually think you are now asking him a personal question. Mr Butt had a long and distinguished career previously as a bureaucrat—he formerly ran the ACT department. He has been an advisor and he has been in the community sector. So his career is long and distinguished, and he fully understands the distinction between roles and responsibilities very clearly. I can assure you that—and you would also know this very well—I am very conscious of the need for appropriate separation. He now provides policy advice, but he does not take decisions one way or the other which can be regarded as a conflict. I am very clear about that.

Senator FIERRAVANTI-WELLS: What was the process in relation to the formation of this new body, and was Mr Butt's position advertised?

Ms Halton : Yes, it was.

Senator FIERRAVANTI-WELLS: What about the process for the establishment of the new national body?

Ms Halton : They were decisions taken by the minister.

Senator FIERRAVANTI-WELLS: Can you tell me what that process now is? When did the government decide that there was a need for a new body to oversee Medicare Local?

Ms Halton : The minister took that decision well before Mr Butt's engagement with me.


Ms Halton : We can give you the dates. If we do not have them here, we will certainly come back to you on notice.

Senator FIERRAVANTI-WELLS: Is there an announcement that you made?

Mr Booth : Yes, an announcement was made by the minister in terms of establishing a national body for Medicare Locals.

Senator FIERRAVANTI-WELLS: That was the announcement. What was the date of the announcement? My question was: when did you—

Mr Booth : It was 19 July.

Senator FIERRAVANTI-WELLS: At what point did you realise you needed a new body?

Ms Halton : We can probably check when there was a decision, but it substantially preceded the announcement.

Mr Booth : That is correct. Mr Butt was talking about earlier about the meeting in February about a national body for Medicare Locals. The actual invitation to apply was well in advance of that.

Senator FIERRAVANTI-WELLS: What is the funding—is there funding for this body?

Mr Booth : There is funding available for the national body.

Senator FIERRAVANTI-WELLS: What about staff and secretariat?

Mr Booth : The AGPN has been invited to put an application forward for the national body. They are going through that process at the moment.

Senator FIERRAVANTI-WELLS: In other words, the AGPN is likely to become the new body?

Mr Booth : The process that has been established is that the AGPN have to go through a process, as Medicare Local had to, in terms of proving their capability and capacity to perform the roles and functions of a national body. They are currently going through that process.

Senator FIERRAVANTI-WELLS: Will there be legislation necessary?

Mr Booth : No.

Senator FIERRAVANTI-WELLS: Will this mean no net increase in bureaucracy? Will this be another body that requires new staff, or will with the staff—

Ms Halton : There is an existing body there. I cannot make a particular comment about individuals, obviously, but I do not believe that you will see a net increase.

Senator FIERRAVANTI-WELLS: No, I understand you have a private entity that is now going to become a new national body, which presumably sits alongside all of those other bodies.

Ms Halton : No, it does not.

Senator FIERRAVANTI-WELLS: It is not going to be part of the Commonwealth?

Ms Halton : No, it is not.

Senator FIERRAVANTI-WELLS: So there will be staff from the department going to this new bureaucracy?

Ms Halton : No.

Senator FIERRAVANTI-WELLS: Mr Butt, I think you told me that all 19 Medicare Locals had already signed their contracts.

Mr Butt : They signed transition contracts for funding agreements from 1 July. They were then transitioning into new funding agreements, to go for a three-year period. I think there is one that is not signed.

Mr Booth : They are practically all signed now.

Senator FIERRAVANTI-WELLS: I have other questions on Medicare Locals, but I will put those on notice, given the interest that there is in GP superclinics.

CHAIR: We will go to GP superclinics.

Senator FIERRAVANTI-WELLS: I might start in relation to Redcliffe. Just by way of summary, so I understand, there have been problems with Redcliffe GP superclinic. It was raised on the last occasion here in estimates. I think Senator Boyce was demonstrated some of the issues quite graphically, with photographs et cetera. It is now going to be bailed out for another $3.2 million, as I understand, from the Commonwealth's perspective.

Mr Butt : Yes.

Senator FIERRAVANTI-WELLS: The funding agreement was signed on 27 January.

Mr Butt : Yes, 2009.

Senator FIERRAVANTI-WELLS: The clinic was promised on 1 October 2007, the funding agreement was signed on 27 January and it was due to be open in July or August this year.

Mr Butt : Yes.

Senator FIERRAVANTI-WELLS: Builders walked off the site, locked the government out and threatened legal action over lack of payment.

Mr Butt : They did not lock the government out. That was a issue between them and the Redcliffe Hospital Foundation. They certainly did not lock the government out.

Senator FIERRAVANTI-WELLS: When did the Redcliffe Hospital Foundation submit its preliminary project plan and budget to the Commonwealth?

Mr Booth : Which initial project plan?

Senator FIERRAVANTI-WELLS: I have a copy of what I think is the standard agreement. I think we canvassed this before. As I understand, with these GP superclinics there is a standard contract that gets varied with each GP superclinic. Is that is the case? That is what I understand from the previous evidence that was given.

Mr Booth : Yes. We do not have the exact date and signing of that, but we can certainly take that on notice.

Senator FIERRAVANTI-WELLS: I would have thought, given what has been in the press lately, you would come here fully armed with all this information. Goodness me—it has been one of the most reported issues in the last month. I would have thought this would be detail that you would have.

Mr Booth : You mean the original signing a number of years ago?


Mr Booth : We do not have the exact date.

Senator FIERRAVANTI-WELLS: When did this hospital foundation submit its preliminary project plan and budget?

Ms Taylor : We do not have those details.

Mr Booth : We do not have the exact date with us.

Senator FIERRAVANTI-WELLS: In that case, did this budget include their financing requirements and costs as required by the funding agreement?

Mr Booth : Yes. There was an assessment process undertaken and, as part of that, the proposal that was put forward included the funding that would be required for the clinic.

Senator FIERRAVANTI-WELLS: Were those financing requirements and costs acceptable to the Commonwealth?

Mr Booth : They were, yes.

Senator FIERRAVANTI-WELLS: How did they propose to finance the project?

Mr Booth : The majority of the project was financed through the Commonwealth grant as part of the GP superclinics scheme. In addition, there was a smaller amount that the foundation proposed to raise through a commercial loan.

Senator FIERRAVANTI-WELLS: So you did not require any amendment of the project plan and the budget?

Mr Butt : In what sense?

Senator FIERRAVANTI-WELLS: As I understand the standard contract, paragraph 3, 'Planning, design and approvals', sets out in great detail what the Commonwealth is going to do and what the organisation is going to do. I would like to go through that and ascertain for myself that the Commonwealth met all its requirements. I would like to know, specifically, at each point, what the Commonwealth did and if they undertook the necessary governance in relation to this project. That is why I am asking details about when you did certain things and what those actions entailed.

I will go back to my initial question. Did you require any change to the plan or budget, or did you notify the organisation that their plan and budget were acceptable? Presumably you get a plan and a budget. You look at it. It tells me in this that you have to review it. It says under clause 3.1(d) it says you will review each project plan and submit and notify the organisation. Did you notify the organisation?

Mr Booth : Yes, as part of the assessment process at the very beginning we would have done.

Senator FIERRAVANTI-WELLS: When did that occur?

Ms Taylor : The original proposal included funding from the Commonwealth plus a considerable amount under a loan arrangement. The Queensland Health people were on that assessment process so that was well known at the time. From that point of view, there was $5 million available for the Redcliffe superclinic site. At a period past that point the minister approved additional funding. There was an additional $5 million approved later as part of last year's election commitments, and that was made very public. When we got to the point in terms of the $10 million versus the $12 or $13 million build, the understanding was that there would be a loan applied for from either commercial purposes or through the Queensland government for the additional money that was required.

Senator FIERRAVANTI-WELLS: Ms Taylor, I asked you a specific question in relation to a process that the Commonwealth was required to undertake. I would appreciate it if you could listen to my question and answer the question that I have asked you. My question was: on what date did the Commonwealth, presumably under clause 3.1(d), notify the organisation that its plan and budget were acceptable?

Mr Booth : We do not have the exact date with us, but we will take it on notice and get the exact date.

Senator FIERRAVANTI-WELLS: This matter was raised in the Senate last week. I raised it with Minister Ludwig. You must have known that this issue would be raised at estimates because we did not get the answer to questions on notice 464 and 465, which particularly pertain to GP superclinics. I raised my concerns in the Senate. You knew this matter was likely to be raised. I would have thought you would come with all your documents. I hope that there was not any deliberate non-bringing of documents. You must have known I would raise these issues. Why don't you have the documents here with you?

Ms Halton : The officers—

Senator FIERRAVANTI-WELLS: It is not acceptable.

Ms Halton : The officers cannot bring every single file they have on Redcliffe or other GP superclinics. They have brought with them their usual compendium, which is quite detailed, about these projects. The fact they do not have a specific date I think is actually completely understandable. They would have to go back through a series of folios to find the specific date you have asked for, and they have said they will do that.

Senator FIERRAVANTI-WELLS: I just do not find that acceptable, simply because in the last week this matter has been raised in the Senate. Don't you get advice? Don't you follow these issues? It was not just in the press; questions were specifically raised of Minister Ludwig.

Ms Halton : I do not recall having read in the Hansard that you specifically raised in the Senate the specific date on which participants were told a budget was acceptable.

Senator FIERRAVANTI-WELLS: That is really being a bit cute.

Ms Halton : No—

Senator FIERRAVANTI-WELLS: You knew we would ask questions on Redcliffe. I shall proceed now with my questions, Ms Halton—

Ms Halton : Please do.

Senator FIERRAVANTI-WELLS: And you can demonstrate what your officers do or do not know. What steps did the Commonwealth take to determine whether the Redcliffe Hospital Foundation had access to sufficient finance before giving Commonwealth approval to commence construction?

Mr Booth : We had specific undertakings from the Redcliffe Hospital Foundation around the loan that they would need to take—

Senator FIERRAVANTI-WELLS: What steps did the Commonwealth take to determine whether the foundation had access to sufficient finance?

Mr Booth : As part of the initial assessment that we did, and that we undertake for every GP superclinic, we did a full financial analysis and probity assessment. We have external financial advisors who come in and work alongside us. We do full assessments of the finances that are put to us before we make an assessment of whether a clinic will be financially viable and that process, as with any superclinic, was undertaken.

Senator FIERRAVANTI-WELLS: So you had documents from the Redcliffe Hospital Foundation?

Mr Booth : As part of their application process they are required to put forward a significant amount of information in terms of—

Senator FIERRAVANTI-WELLS: And you took written or oral undertakings?

Mr Booth : There would have been a written—

Senator FIERRAVANTI-WELLS: Not 'would have been'—were there written or oral undertakings?

Mr Booth : Written .

Senator FIERRAVANTI-WELLS: Written undertakings?

Ms Halton : Written undertakings.

Senator FIERRAVANTI-WELLS: You said 'undertakings'—I take that to be plural.

Ms Halton : If you think about it, there are a number of signed undertakings: firstly, when they submit the budget; secondly, in response to—this is a general answer—any questions that are answered, which are required to be signed off; and, thirdly, when they sign the contract.

Senator FIERRAVANTI-WELLS: Did you provide written confirmation that the Redcliffe foundation could commence construction?

Ms Halton : They have a contract.

Senator FIERRAVANTI-WELLS: What date did that occur—was that on 27 January 2009?

Ms Taylor : Yes, they signed our funding agreement on 27 January 2009.

Senator FIERRAVANTI-WELLS: Did that agreement with the foundation specify that they had to provide financial security—was that a term of that agreement?

Ms Taylor : Yes, it is a standard term of the funding agreement.

Senator FIERRAVANTI-WELLS: Did the foundation provide the financial security as required by section 6.6?

Ms Taylor : Can I just go back. It was always understood that there would be a significant amount of borrowing, and you cannot take out a security against borrowings not yet secured.

Senator FIERRAVANTI-WELLS: I am just asking a basic question. The answer is yes or no. I am asking you whether—

Ms Taylor : There was no money to secure at that point. We understood there would be loans secured. We had seen a business case as part of the proposal for those loans and, at that point, there was nothing to take a security out against.

Senator FIERRAVANTI-WELLS: Paragraph 6.6 of the agreement relates to financial securities. It says, 'the organisation must provide a financial security'. It goes on to detail various aspects of that and then says:

(c) the financial security must be:

(i)   unconditional;

(ii)   on terms satisfactory to the Commonwealth; and

(iii)   from a bank acceptable to the Commonwealth;

My question to you is: did the foundation provide the Commonwealth with financial security as required under the provisions of section 6.6 prior to the commencement of the works?

Ms Taylor : That section could not be invoked when the loan was not actually in place. So there was nothing to secure at that point against the loan.

Senator FIERRAVANTI-WELLS: At what point in time, then, did you propose to invoke that?

Ms Taylor : Once the loan was secured.

Senator FIERRAVANTI-WELLS: And was there anything specific in the agreement in relation to the loan?

Ms Taylor : It was always intended that there would be a loan, yes.

Senator FIERRAVANTI-WELLS: Was there anything specified in the agreement with the foundation that made reference to the loan and how that loan would be obtained—in other words, sections pertaining to the foundation securing a loan?

Ms Taylor : Yes, there would have been a general statement about procuring.

Senator FIERRAVANTI-WELLS: Not 'there would have been'—were there specific requirements in that agreement going to the foundation obtaining a loan?

Mr Butt : There was a specific requirement in the agreement about them obtaining a loan, yes.

Senator FIERRAVANTI-WELLS: Were there provisions in that agreement that went to not only obtaining the loan but, in the event that that loan was not yet obtained, the timing for that loan? What sort of parameters were included in the agreement in relation to that loan?

Mr Butt : I do not have the agreement with me so I cannot recall the detail, but there was a timing issue on the loan that was included in the agreement, and they made an application to the state minister for approval to get the loan in August last year.

Senator FIERRAVANTI-WELLS: At this point in time, given the issues surrounding this, could a copy of that agreement be made available?

Ms Halton : We will take that on notice. If we can, we will provide a copy.

Senator FIERRAVANTI-WELLS: I appreciate that certain things might have to be taken out. My concerns go to the conditions that were imposed from the Commonwealth's perspective. I would not think that those particular aspects of the agreement would be such that they ought not to be disclosed. I mean, given the fact that we have now got to cough up another $3.2 million, I would have thought that it should be made available.

Did the foundation provide the Commonwealth with detailed statements of income and expenditure, and a statement of its current cash at bank, every three months as required by the funding agreement?

Ms Taylor : As far as I am aware, they have.

Senator FIERRAVANTI-WELLS: On what date did the foundation sign the construction contract?

Ms Taylor : January 2010.

Senator FIERRAVANTI-WELLS: What was the value of the construction contract?

Ms Taylor : It was just over $11 million and then there was GST on top of that.

Senator FIERRAVANTI-WELLS: $11.65 million—something like that?

Ms Taylor : Something around that basis.

Senator FIERRAVANTI-WELLS: At the time that they signed the construction contract, what access to funds did they have? Had they already arranged finance? And, if not, why not, and had they provided an explanation to the Commonwealth as to why they had not arranged finance?

Ms Taylor : The understanding was that they would be applying to the Queensland government for a loan, and that process happened in August. At that point we had seen a business case, it is my belief, for commercial lendings, which we had seen, and they needed permission to actually go ahead to apply to the banks at that point from Queensland Health before they could pursue that process.

Senator FIERRAVANTI-WELLS: So when did you become aware that the foundation had signed this $11 million contract and had only accessed $6.7 million in secured funding?

Ms Taylor : I could not tell you the exact date. I will take that on notice.

Senator FIERRAVANTI-WELLS: When did the minister become aware of this?

Ms Taylor : I do not know.

Senator FIERRAVANTI-WELLS: It is a very pertinent question. Will you take it on notice?

Ms Halton : She may not be able to answer that question.

Senator FIERRAVANTI-WELLS: Senator McLucas, will you take that on notice?

Senator McLucas: I will see what I can find out for you.

Senator FIERRAVANTI-WELLS: I would have thought that, given the debacle that this Redcliffe has become, that would be uppermost in the minister's mind. Can you also tell me what action the minister took at the point that she did become aware of this? What is the department's understanding? Let me rephrase that: at what point was the department instructed by the minister to take action, following the minister becoming aware that the foundation had access to only $6.7 million? I accept there are dates. The minister becomes aware; I assume the minister then informs the department—or the other way around?

Mr Butt : Just to be clear about it: as we have already said, there was $10 million put forward by the Commonwealth and there was $1.7 million being put forward by the University of Queensland at a certain date. There was an extra $1 million that they were putting in themselves. So the loan component was a separate component on top of it. It was always known it was going to be required. This is a fairly unique situation. A loan component is not unusual in constructions and super clinics; it is quite common. This is quite unique in that they had to get the permission of the Queensland health minister—or the Queensland Treasurer, in fact—to secure a loan. So the foundation went to the state health minister in August last year and asked for that. At the time they were in negotiations with two commercial banks about borrowings, which they had been told they would be able to get. Queensland Health came back to them and said it should be a Queensland Treasury Corporation loan, so they then worked on that basis and did not proceed with the commercial loans. The thing continued to get delayed in terms of the approval from the state health minister, and it was only in September, after work had ceased because they had not been able to get the loan, that the Queensland health minister then determined that he would not support them going for a loan. Hence, we needed to take further action. And, as I say, it is quite a unique situation in the fact that they were not able to get the loan.

Senator FIERRAVANTI-WELLS: You are aware obviously of the comments by the Queensland Auditor-General in the annual report; I will not refer to those. Basically, of the Redcliffe Hospital Foundation, he says: 'Without further qualifying my opinion, attention is drawn to note 18 to the financial report which indicates that the foundation has entered into a construction contract during the year ended 30 June 2010 with a financial obligation of $11.6 million. The foundation has only secured funding of $6.7 million for the construction. This matter indicates the existence of a material uncertainty which may cast significant doubt about the foundation's ability to continue as a going concern and whether it will realise its assets and extinguish its liabilities in the normal course of business and at the amount stated in the financial report.'

Mr Butt : The Queensland Audit Office report was a report across the whole of government, and it certainly gave a qualified opinion on the Redcliffe Hospital Foundation—but then it gave qualified opinions on other organisations, including Queensland Health. In fact, at that stage, they had already secured $10 million from the Commonwealth, so it was not up to date in that sense. But we were working on the basis, quite understandably, that, for a facility which is going to be a magnificent facility for the people of Redcliffe, the amount of capital being put in by the Commonwealth and others, along with the operational capacity of the facility, would more than support a loan of that nature.

Senator FIERRAVANTI-WELLS: On 14 August 2010 you announced a further $5 million to fast-track specialist services. What has happened to that $5 million?

Mr Butt : Again, it is part of the overall capital for that building.

Senator FIERRAVANTI-WELLS: Was it paid to the Redcliffe foundation?

Mr Butt : Yes.

Senator FIERRAVANTI-WELLS: And from what program was it drawn?

Mr Butt : The GP superclinic program.

Senator FIERRAVANTI-WELLS: And is it in the GP superclinic program; it is not identified specifically as an extra payment?

Mr Booth : I think it is part of the program.

Senator FIERRAVANTI-WELLS: Just part of the overall program from the bucket of money—okay. On 10 October recently the minister announced the $3.2 million bailout. The media release refers to the foundation and the Commonwealth agreeing to make variations to the existing funding agreement to include new approval requirements for finalization of the construction fit-out of the facility. Don't these powers already exist under the existing funding agreement under clause 4.8?

Mr Butt : There are specific powers within the agreement, but these were actually specific steps we required the foundation to take in relation to the situation which we had reached, where the state minister had not approved them taking a loan; hence this unique circumstance where we needed to inject further funds to complete the building. Those arrangements, which are included in a new deed, include things such as appointment of a building superintendent to oversee finalisation of the capital, the engagement of a clinical services planner to help identify a third party operator and then the engagement of a third party operator to manage the facility.

Senator FIERRAVANTI-WELLS: In view of what has happened with Redcliffe, does that mean you will be amending the standard funding agreement?

Mr Butt : No, as I said, this is a pretty unique circumstance; we are not aware of others where there is a requirement for a state health minister to approve them getting a commercial loan.

Senator FIERRAVANTI-WELLS: So, in conclusion, what is now the total Commonwealth commitment to the Redcliffe Superclinic?

Ms Taylor : It is $13.22 million.

Senator FIERRAVANTI-WELLS: And what is the total expenditure to date for the clinic?

Ms Taylor : The original $10 million and just under $2 million that was paid last week for the outstanding bills.

Senator BUSHBY: I have some questions about the rural GP superclinic. There were suggestions in the media that Sorell Integrated Health asked for additional funding. Can you advise what date they asked for additional funding, if in fact they did?

Ms Taylor : The funding agreement was signed on 3 March 2010. We became aware on 1 September 2010 that they had drafted a series of architectural plans that were well and truly above what was available to be built with the money that existed at the time, and it was at that point that the Sorell Integrated Health group suggested that they might like some more money.

Senator BUSHBY: Do you mean that the government's response was that it was not available? Did you advise them of that in a formal way?

Ms Taylor : Absolutely, they were advised at that point that there was no additional funding and probably at half-a-dozen points between then and now.

Senator BUSHBY: What was the date that you advised on that?

Ms Taylor : The first point I know was at the September 2010 meeting. It could have been earlier than that in general conversations. The meeting was between the department and the architects, Sorell Integrated Health, to talk about the discrepancy between the plans and the available funding.

Senator BUSHBY: The minister a couple of weeks announced that the superclinic was not proceeding, on the basis that the Sorell Integrated Health Ltd had withdrawn from it. When did Sorell Integrated Health Ltd advise the Commonwealth that they did not wish to proceed with the clinic?

Ms Taylor : I do not think the term 'withdrawn' was used in the media announcement by the minister. Sorell Integrated Health had an extra six weeks—this was not too far back—to investigate a number of options. We then went back down to Tasmania to talk about lack of progress and what we might be able to do to sort this out. At that point, the terminology that was used by the Sorell Integrated Health people to us, as a result of that six-week investigation, was: 'We are therefore unable to establish a viable GP superclinic in Sorell within the remaining grant funds.' That is pretty explicit.

Senator BUSHBY: There was a funding agreement signed on 3 March last year. Has that funding agreement been terminated?

Ms Taylor : No. We have commenced action to do that, but at that point it had not been terminated.

Senator BUSHBY: Was any money paid to Sorell Integrated Health Ltd under the GP superclinic program?

Ms Taylor : Yes.

Senator BUSHBY: How much?

Ms Taylor : Around about half a million dollars. That was primarily for architectural fees, and some council and project management fees were incorporated into that amount.

Senator BUSHBY: Will you be seeking to reclaim any of that?

Ms Taylor : We will have to look at that.

Senator BUSHBY: I presume that none of it has been refunded at this point?

Ms Taylor : At this point, no.

Senator BUSHBY: I guess it is fair to say that the first time you became aware that this would not be proceeding was at that meeting where you were advised that they would be unable to establish a clinic given the funding.

Ms Taylor : As I said, there was a considerable track record of discussions between us and Sorell Integrated Health leading to that point. The repeated message was that there was no more money. We thought we had got some agreement for them to progress to construction at a number of points between October last year and now, and that simply did not happen. But, in terms of that final advice, that was the letter that came—I am just looking for the date—

Senator BUSHBY: What was the date of that?

Ms Taylor : On 3 June 2011 we went down to Sorell and on 25 July we received the report.

Senator BUSHBY: You received a report from Sorell Integrated Health?

Ms Taylor : Yes.

Senator BUSHBY: So that, effectively, was the day that you became aware that the clinic at Sorell would not be proceeding—

Ms Taylor : That was the day I became aware that they had said they could not proceed.

Senator BUSHBY: At that point you accepted that that was the case?

Ms Taylor : After all the work we had done, and that was the culmination of that latest six-week exercise to actually establish whether there were any other options, that was my understanding at that point.

Senator BUSHBY: Are you aware that, since the minister made the announcement that it would not be proceeding, Sorell Integrated Health have publically stated that they have not advised you that they do not wish to proceed with the GP superclinic?

Ms Taylor : I am aware that they have made that statement.

Senator BUSHBY: Has the department taken any action since you became aware of the conflicting nature of their statement and what you understood to be the case?

Ms Taylor : We have been in contact with Sorell Integrated Health on several occasions since that point.

Senator BUSHBY: What was the outcome of that contact?

Ms Taylor : I am not sure what you mean. We had the conversation—

Senator BUSHBY: Has there been any change in your understanding in terms of their intention to proceed?

Ms Taylor : No.

Senator BUSHBY: Do you have any response today to their comment:

We've definitely not withdrawn from the project. The Minister's release is absolutely wrong.

Ms Taylor : I think there is a semantics issue here. Clearly they said to us that they are unable to proceed on the basis of the current money. We have clearly said to them on half-a-dozen, if not more, occasions and in writing from the minister that there was no more money available. They gave us a report that clearly said: 'We are unable to establish a viable GP super clinic in Sorell within the remaining grant funds.' I am not sure how else people would think that that would go.

Senator BUSHBY: I will leave that there. Can you advise me whether the $2.5 million that was allocated for Sorell, and I guess less the half a million dollars that has already been spent, will still be used to fund primary health care services in Sorell or surrounding region?

Ms Taylor : My understanding is that there have been announcements made in that regard but there are no specific projects that I am aware of at this point.

Senator BUSHBY: What announcements were made?

Ms Taylor : I believe the minister indicated in her media release of the 7th that the money was going to be looked at in terms of the Sorell and community areas.

Mr Butt : Yes, the minister's release said that they were working with the local community to investigate other ways of improving frontline help facilities for Sorell and surrounding communities.

Senator BUSHBY: But there is no decision that has been made as to how that might occur at this point?

Ms Taylor : Not at this point, not that I am aware of.

Senator BUSHBY: Has the department been in discussion with any other general practices or alternative providers in Sorell regarding the reallocation of that?

Ms Taylor : No.

Senator BUSHBY: Thank you, I will leave it at that.

Senator ADAMS: With the consolidation of 159 funding programs into 18 new or expanded flexible funds, I want to ask a question about, as part of this consolidation, the regionally tailored primary health care initiatives through the Medicare Locals Fund. Is this the right place to ask that?

Mr Butt : Yes.

Senator ADAMS: Activities to be supported under this fund include some specific rural programs such as workforce support for the Rural GPs Program, the Rural Primary Health Services Program and the Rural GP Locum Program. It also includes some generic programs such as Medicare Plus Better Aged Care Residents (Aged Care Access Initiative), the allied health component, primary health care organisations, Medicare Locals, and improving access to general practice and primary health care services for older Australians. My question is: what proportion of a Medicare Locals discretionary funds are likely to be provided from this fund?

Mr Booth : As you are aware, Senator, where we are heading with the flexible funds is to consolidate a number of separate funding streams into single larger funds so that we can gain efficiencies from doing that. Those funds have been established, guidelines have been issued for a number of the funds, and we are just going through the process at the moment. In terms of the Medicare Locals Fund we will be developing that over the next few months.

Senator ADAMS: What other resources will be available to a Medicare Local for its gap analysis work and work to follow up on identified gaps?

Mr Booth : There was a specific amount of funding made available to all Medicare Locals on establishment which was core funding to enable them to carry out functions such as needs analysis. The total amount of funding available to Medicare Locals was $173 million, which was roughly twice the amount available previously to divisions of general practice.

Senator ADAMS: Have you started consultations with the Medicare Locals on how they are going to use this fund?

Mr Booth : There are two aspects here. One is the core funding to enable Medicare Locals to do that and that goes through the standard funding agreements with the Medicare Locals. In terms of the flexible fund we will be moving down that fairly soon. The issue with the flexible fund for Medicare Locals is of course that not all Medicare Locals are yet established. As we have said there are 15—

Senator ADAMS: Yes, I meant the ones that are established, I suppose.

Mr Booth : But we are putting our timelines in in conjunction with the establishment of the Medicare Locals.

Senator ADAMS: So how is the department going to ensure that allocations under this very diverse flexible fund will meet the specific needs of people in rural and remote Australia? And, secondly, will other rural and remote interest groups be consulted? I was not sure whether it should come under rural health—

Mr Booth : We can talk about it here. Certainly the intention of the flexible funds is to give flexibility within those areas. Initially the funding that is within the flexible funds will continue in the areas that it is established at the moment, so in that sense the fund will not actually come online until the Medicare Locals are all established so there will not be any initial changes around that.

Another aspect to talk about is, of course, the intent of Medicare Locals is to be able to respond to local need. If Medicare Locals are in rural and remote areas they will have specific needs which will come up as part of that needs analysis program and that is contained within the core funding that they obtain.

Mr Butt : The core funding is based on a funding formula which takes into account rurality, for example, so it does take into account weightings for rural people, aboriginality, socioeconomic status—a whole range of factors that come into it.

Senator ADAMS: Thank you. I will have some more questions on that next time. My second question is on the redirection of the domestic violence referral point project. This is something that was in Budget Paper No. 2 at page 243. I had quite a discussion about this last time. I asked a question on notice and I am still not happy with the reply, so I would like to continue the discussion.

Mr Booth : Essentially what has happened with respect to the domestic violence prevention campaign is that the campaign was split between two different departments: the Department of Health and Ageing and FaHCSIA. The take-up of the incentive in terms of practices that were taking up the incentive was very low. The numbers in terms of people actually going on training in terms of domestic violence prevention was very low. So an analysis was done of the program and as a result of that it was decided that the program should be consolidated. Rather than splitting it across two agencies it should be consolidated into a single agency, and it has been consolidated within FaHCSIA and they are now running the program. My understanding from FaHCSIA is that FaHCSIA is intending to create a new program to improve support services for women in regional, rural and remote communities. The intent is that by combining the two areas together, the number of programs will be able to be increased.

Senator ADAMS: I have got that on the question on notice. I am a bit confused. In the budget paper it says:

This measure will provide savings of $12.2 million over five years which will be redirected to support other Government priorities, delivering on the Government's commitment to responsible economic management.

The question on notice, which I received from the department recently, says, 'The redesign, together with the consolidation of administrative responsibility within a single agency, will result in efficiencies of $12.2 million over four years, while increasing the number of services provided', et cetera. There is a slight discrepancy there—five years and four years. Could you explain that please?

Ms V Murphy : I think we will have to take that on notice. I cannot explain why there is a discrepancy.

Senator ADAMS: The question on notice I am referring to is E11-463. It is under 'domestic violence referral points.

Ms V Murphy : I think we will have to take that on notice. I am not quite sure why the discrepancy is there. I think it should read 'four years', not 'five years'.

Senator ADAMS: It is five years in the budget paper and four years in your reply.

Mr Booth : We will investigate that discrepancy, but my understanding was $12.2 million over four years.

Senator ADAMS: That $12.2 million in savings over four years or five years: where is that going to go? I am quite concerned, because domestic violence is something that I follow very strongly and I would like to know whether that is going to be removed from the health budget and go into some other hole, or is it going to be kept in health and extended into another useful program?

Ms V Murphy : The program dollars have not been allocated to anything specifically, so we cannot answer that.

Mr Booth : But the savings in terms of the $12.2 million over four years is essentially an accounting area, because the people who would have been working on this in the department of health, because the program has been combined into FaHCSIA, will not be doing that work anymore. So that saving goes back into departmental funds.

Senator ADAMS: It will go back into the FaHCSIA budget or the department's budget, or which budget?

Ms Halton : My understanding is that this was a saving in running costs because we are not administering our side of this program, so there was a net save but it was a saving back to bureaucrats.

Mr Booth : That is correct. It is a saving to the department.

Ms Halton : It is not a saving to the department—that is what is confusing people.

Mr Booth : Apologies; yes.

Ms Halton : It is a net save but it is from administration.

Senator ADAMS: So that would be across $53 million if it is over four years, $3 million in administration, for that program.

Ms Halton : As I said, Senator, I think we should give you a clearer explanation of what savings have been taken and which money has been moved, so you can understand.

Senator ADAMS: Thank you very much.

Senator FIERRAVANTI-WELLS: How many GP superclinics have requested extra funding above the original Commonwealth commitment?

Ms Taylor : The other sites that have received additional funding are Wallan in Victoria and Mount Isa in Queensland.

Senator FIERRAVANTI-WELLS: From which program was this funding drawn?

Ms Taylor : GP superclinic.

Senator FIERRAVANTI-WELLS: Have any GP superclinics received additional funding under the Health and Hospital Fund?

Ms Taylor : Yes. Wallan has, which was an extension of the primary care facility to go in there.

Senator FIERRAVANTI-WELLS: I will come to Wallan in a moment. So no GP superclinic has applied and been denied additional funding?

Ms Taylor : I could not answer that question, I am sorry.

Senator FIERRAVANTI-WELLS: Please take that on notice. Has the department advised GP superclinic operators to apply for further funding under other health programs and, if so, what are the programs? Could you take that on notice please?

Ms Taylor : No, I can tell you that now. As a general rule we make funding recipients aware that there are other funding pools in the department, such as the HHF pool, but other than making them aware that is the extent of our involvement.

Senator FIERRAVANTI-WELLS: When did the department realise that there were no applications for the Darwin GP superclinic?

Mr Booth : The invitation to apply was advertised on 8 and 11 June in the Northern Territory News. The invitation to apply was open for six weeks and following that there were no applications.

Senator FIERRAVANTI-WELLS: Can you tell me why the minister did not announce until 12 October that there had been no applicants for the Darwin superclinic despite it being known in the department since 20 July?

Ms Halton : That is a matter for the minister.

Senator FIERRAVANTI-WELLS: When the department realised that there were no applications for the Darwin superclinic what action did it take? Did you inform the minister?

Ms Halton : We would have to go back and have a look to see exactly what form—

Senator FIERRAVANTI-WELLS: Can you take on notice the steps after 20 July, including when you advised the minister?

Ms Halton : Yes.

Senator FIERRAVANTI-WELLS: Senator McLucas, could you take on notice why the minister did not announce until 12 October that there had been no applicant for the Darwin clinic despite there being information available in the department since 20 July?

Senator McLucas: I will see what the minister would like to add.

Senator FIERRAVANTI-WELLS: The Warnervale superclinic is one I have kept a weather eye on in Dobell. Has Warnervale Medical Services Pty Ltd advised the Commonwealth that it proposes a variation to the works?

Ms Taylor : Yes.

Senator FIERRAVANTI-WELLS: Are you aware of the various discussions that have gone on in council in relation to that or has Warnervale Medical Services made the Commonwealth aware of those issues?

Ms Taylor : We are aware that there have been quite considerable delays in the council around approvals for that complex.

Senator FIERRAVANTI-WELLS: Are you also aware that the proposal by Warnervale Medical Services and changes that they themselves have made to the works now mean that the proposed GP superclinic is about a quarter of what was originally anticipated?

Ms Taylor : That is not precisely the case. The issue was—

Senator FIERRAVANTI-WELLS: Well, is the size considerably less than was originally proposed?

Ms Taylor : The GP superclinic component of that overall medical facility is still the same size. There were a number of other facilities that were going into that overall complex, which included a private hospital, a range of specialist offices and some additional untenanted space that was basically there for medical services to go in there. But the GP superclinic component of it remains the same.

Senator FIERRAVANTI-WELLS: On what date was the Commonwealth advised that there was a variation to the work, and has the Commonwealth provided its consent in writing to that variation?

Ms Taylor : There have been several variations around the revised works. The applicant requested formal approval back in November. We would have approved that from that point. I think there was another more recent one as well, given the length of time this had sat in council. I need to clarify that. But certainly we are aware of variations to that medical complex.

Senator FIERRAVANTI-WELLS: Okay. I will put some further questions on notice in relation to that.

Have any representations been made in relation to any aspect of Warnervale GP superclinic by Mr Thompson, the member for Dobell?

Ms Taylor : I am not sure what you mean.

Senator FIERRAVANTI-WELLS: I think you know what 'representation' means.

Ms Taylor : Not that I am aware of specifically.

Senator FIERRAVANTI-WELLS: Has the department received any correspondence? Could you take that on notice?

Ms Halton : We will certainly check and see if there is any anywhere in the department.

Senator FIERRAVANTI-WELLS: Yes, and to the minister. Can you also take that question: have any representations been made to the minister by Mr Thomson, the member for Dobell—absent member for Dobell—in relation to the Warnervale GP superclinic and any responses that either the department or the minister have given Mr Thomson or his office in relation to that superclinic?

I might ask some questions in relation to the Wallan GP superclinic. Can you explain the difference between the Wallan Integrated Primary Healthcare Centre and the Wallan GP superclinic? Are these the same organisation?

Ms Taylor : Mitchell Community Health Services, I understand, is the potential operator of those facilities. They are certainly our funding recipient. I believe that that will be one and the same facility.

Senator FIERRAVANTI-WELLS: I understand that the funding agreement was signed on 13 April with $1 million attached to it, and I also understand that under the Health and Hospitals Fund $2.6 million has been provided for the development of the Wallan Integrated Primary Healthcare Centre. Is this money for the GP superclinic coming out of the Health and Hospitals Fund?

Ms Taylor : No.

Senator FIERRAVANTI-WELLS: No? Could you explain what parts of that facility are being funded by the GP superclinic fund as opposed to the Health and Hospitals Fund?

Ms Taylor : The GP superclinic funding was $1 million. That was increased by $2.5 million on 7 July due to the land issues, which I think were much publicised. I am not aware of the exact figure that went in from the Health and Hospitals Fund, but that certainly would have been its own separate funding; superclinic money went in as the superclinic money.

Senator FIERRAVANTI-WELLS: But for the same facility—that is, a GP superclinic?

Ms Taylor : I understand that there is significant extra space going in there.

Senator FIERRAVANTI-WELLS: For purposes other than the GP superclinic?

Ms Taylor : That is my understanding.

Senator FIERRAVANTI-WELLS: I will put some further questions on notice in relation to that.

CHAIR: Senator Fierravanti-Wells, I know you are doing a trade-off with mental health.

Senator FIERRAVANTI-WELLS: I am taking a little bit of time from mental health. I have some questions in relation to Riverina, which I will put on notice. I have one question in relation to South Morang: Will dental services be included at the South Morang GP superclinic, as promised?

Ms Taylor : The dental services were never a promise for the GP superclinic—that was not part of the original proposal. That particular funding recipient, as far as I know, currently delivers dental services to that area, but that was not part of the GP superclinic. I think they had a desire, possibly, to include that in the GP superclinic facility, but that was never actually part of the planning.

Senator FIERRAVANTI-WELLS: Thank you. That is probably way over time now. Thank you, Chair.

CHAIR: There being no more questions under outcome 5, I thank the officers. I know there will be numerous questions on notice. Thank you very much.

Proceedings suspended from 15:46 to 16:02

CHAIR: We will now go to outcome 11, which is mental health.

Senator FIERRAVANTI-WELLS: First of all, I thank your department, Ms Halton, for filling in my tables for me in relation to the COAG funding from 2006-11. That was very helpful. Ms Harman, were you responsible for filling in the table for me?

Ms Harman : My very talented team were. It was a cross-divisional effort.

Senator FIERRAVANTI-WELLS: Thank you. In relation to the Better Access scheme money and that total over five years, the $2053.7 million for Better Access, as opposed to—having gone back to the budget papers back in 2006, the amount that was set aside was $538 million. But I understand—correct me if I am wrong—that that money was an amendment to the Medicare Benefit Schedule, so the $538 million was meant to come out of MBS and that bucket of money rather than program money out of the department. Could you clarify that for me?

Ms Harman : The better access scheme, as you know, is a Medicare funded initiative, so it would be a demand driven appropriation put into the forward estimates. My understanding is that these figures include education and training programs, which are treated slightly differently, and those have a program amount allocated to them. Better access is a demand driven Medicare based program, so the moneys in the forward estimates would be an estimate of future demand and would be appropriated to the MBS bucket. However, I just want to clarify that the understanding of the figures that we have given you in this table is that they also include some program related funding around education and training, so it is a combination of both of those things.

Senator FIERRAVANTI-WELLS: I think rather than trawling through this, Ms Halton, if you do not mind, perhaps Ms Harman could be made available. There are a few questions I would like to ask in perhaps a short briefing if that could be arranged. I will apply to Minister Butler, if that is okay.

Ms Halton : Fine.

Senator FIERRAVANTI-WELLS: It might be easier rather than trawling through bits and pieces. I can bring my folders and do it that way—thank you. I would like to ask some questions in relation to the National Mental Health Commission. The other day I asked some questions in Prime Minister and Cabinet. Perhaps if I could ask first off, Ms Halton, in relation to the minister's now dual responsibilities, ageing and mental health, and clearly I know those responsibilities—

Ms Halton : And health and medical research as he keeps reminding us.

Senator FIERRAVANTI-WELLS: Yes. I am looking at it in so far as I am concerned. This responsibility of minister assisting obviously has a much broader whole-of-government approach.

Ms Halton : Correct.

Senator FIERRAVANTI-WELLS: The other day when I was asking PM&C questions about the National Mental Health Commission, it was interspersed with what Minister Butler did and what the Prime Minister's department did. I am going to ask some questions here. I would assume from those answers that were given by PM&C that, whilst this is in the Prime Minister's department, will the day to day, if I can talk about the logistics of the National Mental Health Commission, still remain with Minister Butler in this department? The lines weren't clear, and I did not have the time to pursue it.

Ms Halton : Let me see if I can help by saying that the commission is in the Prime Minister's portfolio and that is for the purposes of reinforcing, as I understand it, that this is a whole-of-government issue. As much as I sit here with all our agencies, it is very clearly in the portfolio of the Prime Minister's department. Obviously, as the department which has the most day-to-day and detailed interest in mental health issues, we take a very close interest in what the commission are going to be doing but for food, watering, provisioning, et cetera, it is a Prime Minister's department issue.

Senator FIERRAVANTI-WELLS: The reason I have asked these questions is that the press releases in relation to the National Mental Health Commission appear to be being made by Minister Butler. For example, the first of June, 'First steps towards National Mental Health Commission', where he announces the appointment of Ms Kruk as the CEO designate of the new commission. He talks about the nine commissioners and the chair. He talks about transparency and accountability in the mental health system, which I will come to in a moment. There is also 7 September where he announced the appointment of Monsignor Cappo as the National Mental Health Commissioner. I saw the reports in the press and I understand that Minister Butler has now put out a press release in relation to Professor Fels but I will come to that in a moment. I am asking these questions because it seems that the press releases do not come from the Prime Minister; they are coming from Minister Butler.

Ms Halton : You would expect that; he is the minister assisting the Prime Minister.

Senator FIERRAVANTI-WELLS: I will ask them in that capacity. Was the decision to appoint Monsignor Cappo made through the Prime Minister or was it made on the recommendation of Minister Butler?

Ms Halton : Again, that is not a question we can answer, because that body sits in the Prime Minister's portfolio; that is not a matter in relation to which we have any role.

Senator FIERRAVANTI-WELLS: Do I understand that the department had no role in relation to the appointment of Monsignor Cappo as the National Mental Health Commissioner?

Ms Halton : Correct. As you would understand, we talk to the minister a lot about all sorts of bits and pieces, and certainly we talk to the Department of the Prime Minister and Cabinet all the time, but the process of appointment is a Prime Minister and Cabinet issue. Does that make sense?

Senator FIERRAVANTI-WELLS: Yes. I do not have it with me but I would appreciate it if you could review the evidence given by PM&C the other day and make any comment in relation to it.

Ms Halton : I would be happy to—maybe directly to them, depending on what I think of it.

Senator FIERRAVANTI-WELLS: Yes, thank you. I am sure that you will in your inimitable style, Ms Halton, because what you are telling me today does not sit very squarely with what I was told the other day.

Ms Halton : I gather it might have been Mr Eccles?

Senator FIERRAVANTI-WELLS: Mr Richard Eccles. That is absolutely—

Ms Halton : Yes, Mr Richard Eccles might be getting a telephone call if I disapprove of what he has had to say.

Senator FIERRAVANTI-WELLS: I think you should review what Mr Eccles had to say because he seemed to be fobbing it off to Health rather than dealing with it himself.

Ms Halton : Did he? I will no doubt form my own opinion, but, as you would well understand, if I have anything to say to Mr Eccles you can be quite confident I shall say it.

Senator FIERRAVANTI-WELLS: Perhaps you might clarify it for my purposes as well.

Ms Halton : When next we see each other, absolutely.

Senator FIERRAVANTI-WELLS: Thank you. For the record, I asked questions in relation to the short listing of suitable candidates. Health and Ageing had nothing to do with the drawing up of any short list of candidates or any consultations with the mental health sector, consumers, carers, peak bodies in relation to who should be the National Mental Health Commissioner.

Ms Harman : As Mr Eccles said to you, as I understand it, there was no short list. The appointment of Monsignor Cappo was a usual process that resulted in a cabinet decision and that is a usual appointment process for a significant appointment of that kind. The department was involved in providing advice to our portfolio ministers in respect of suggested names. The Minister Assisting the Prime Minister on Mental Health Reform, Minister Butler, wrote to his ministerial colleagues asking for their nominations or their suggestions and we provided advice to our Minister Roxon and Minister Snowdon following a request from them.

Senator FIERRAVANTI-WELLS: So there was a process in the sense that Minister Butler wrote to his colleagues inviting them to make suggestions for this position?

Ms Harman : That is correct—reflecting the whole-of-government interest in getting a range of commissioners.

Senator FIERRAVANTI-WELLS: I was interested in the appointment of 7 September. The story appeared in the Fairfax press before the minister actually made the announcement. I was interested from two points of view, one is that it was there in print—

Ms Harman : If I could just clarify my previous answer, which was advice that the department gave to Minister Roxon and Minister Snowdon in respect of the commissioners broadly, not the chair.

Senator FIERRAVANTI-WELLS: I see—about the nine commissioners?

Ms Harman : That is correct.

Senator FIERRAVANTI-WELLS: If I understand correctly from PM&C, the chair was purely a matter for discussions.

Ms Halton : A decision of government.

Senator FIERRAVANTI-WELLS: 'A decision of government' was the short-term phrase used?

Ms Halton : Yes.

Senator FIERRAVANTI-WELLS: Minister Butler put out a statement on 15 September, and there were various other statements attributed to his office in relation to Monsignor Cappo being the obvious choice. Was the department consulted at all in relation to this point that Monsignor Cappo was the obvious choice? There seems to be this repeated comment in the press about Monsignor Cappo being the obvious choice; was there any consideration given at any stage to any other person?

Ms Harman : That is a question that I am not able to answer; that is a question for Prime Minister and Cabinet.

Senator FIERRAVANTI-WELLS: Senator McLucas can you take that one on notice? This was repeated, particularly after the announcement was made—there were these references to Monsignor Cappo being the obvious choice. In light of what is in the public arena and was in the public arena and indeed was in the public arena before the announcement of Monsignor Cappo as the National Mental Health Commissioner, why did the minister persist in referring to Monsignor Cappo as the obvious choice in circumstances where it appeared that nobody else was considered, and given Monsignor Cappo's history? How could he still maintain the view that Monsignor Cappo still is the obvious choice, because in his press statement when he resigned the minister said:

I still believe that, given his background and expertise, Monsignor Cappo was the obvious choice to lead the Mental Health Commission.

I do not want to go into those issues here, but given the very serious matters that were raised in the press, and indeed by Senator Xenophon, I would like to put that question on the record and get a response from the minister. Can I then ask what would be the working relationship between the National Mental Health Commission, the new commissioner, the chair and the nine commissioners? Have we worked that out yet? What will be the working relationship between Health and Ageing and Prime Minister and Cabinet in relation to this?

Ms Harman : As the commission is due to be established on 1 January next year, it does not formally exist yet. Having said that, the department has been working closely with PM&C and has met with Ms Kruk on a number of occasions to provide her with information and briefing, so we expect that to be a very close and collegiate working relationship.

Senator FIERRAVANTI-WELLS: Who is going to discuss with Ms Kruk her remuneration? I notice from the Senate orders tabled by the President on 11 October that her remuneration is yet to be determined and indeed Monsignor Cappo's remuneration was yet to be determined as well.

Ms Halton : You would be aware that as a former secretary of a department there are particular arrangements that apply to Ms Kruk—I think you would be aware that she had a period of sick leave—and there is a provision in the act at the moment that talks about the employment of former secretaries.

Senator FIERRAVANTI-WELLS: What, the Ken Henry section 64 type of appointment? By the look on your face, you do not want to go there.

Ms Halton : I could not make a comment about that particular issue.

Senator FIERRAVANTI-WELLS: It is not one of those types of appointments?

Ms Halton : I think the question of how the Remuneration Tribunal treats this will by definition take account of the fact that she is actually a former secretary and various provisions of various acts will apply to her which might not to others.

Senator FIERRAVANTI-WELLS: But my question is who is going to engage in those negotiations—which department will have the lead on that? Will that be PM&C?

Ms Halton : PM&C.

Senator FIERRAVANTI-WELLS: And likewise with the chair?

Ms Halton : Yes. They would have to put in those submissions.

Senator FIERRAVANTI-WELLS: And likewise with any remuneration due to the commissioners?

Ms Halton : Absolutely.

Senator FIERRAVANTI-WELLS: I will now move to the 10-year roadmap. I understand that this is to be due before the end of the year—is that the case?

Ms Halton : That is correct.

Senator FIERRAVANTI-WELLS: Ms Kruk is not starting until 1 January and the chair appears not to be formally starting until 1 January as well, although I assume, from the documents tabled by the president—is that the case? When is Professor Fels officially starting in his new role—do we know?

Ms Halton : No. I think this will actually be a bit like the conversation we had a bit earlier on about the IPPA. We have a pro tem CEO, to wit Ms Kruk, who can undertake duties, but the chair, by definition, requires a formal start date, which is the beginning of the year. As Ms Harman has already indicated, we have had a number of conversations with Ms Kruk. She is well engaged now but the chair is a slightly different matter.

Senator FIERRAVANTI-WELLS: The roadmap and the COAG process is underway and due before the end of the year. What role will Ms Kruk—certainly the chair will not have an input before the end of the year—and the commissioners have in relation to the roadmap process?

Ms Harman : The government has made it clear that the role of the commission in respect to the roadmap is to monitor progress against the roadmap once it is agreed by government.

Senator FIERRAVANTI-WELLS: So, at this stage, there is no role for Ms Kruk, the chair or the commissioners?

Ms Halton : No, but I would emphasise that in the drafting of the roadmap there is a COAG working group, of which I am chair, working on a draft of the roadmap for consideration by ministers, COAG et cetera. It is fair to say that the consultation around input structure, form et cetera is very widespread and all encompassing, and Ms Kruk is included in that process. Obviously, as Ms Harman has indicated, when the formal commission is up and running it will have a particular charter, but Ms Kruk is very experienced—indeed a psychologist—so it would be perfectly prudent to take some advice from her.

Senator FIERRAVANTI-WELLS: I was senior private secretary to John Fahey when she was Deputy Director-General of the NSW Department of Premier and Cabinet, so I know Ms Kruk very well.

Ms Halton : As indeed do I, as you would know well.

Senator FIERRAVANTI-WELLS: It is a long history. I will leave my questions there. I have some questions in relation to mental health workforce issues and how they fit into the bigger picture and the 10-year roadmap. Ms Huxtable, is it appropriate to ask them here or in 'Workforce'?

Ms Huxtable : It probably depends on what the questions are.

Senator FIERRAVANTI-WELLS: I will just launch in. Take headspace, for example. We know we are looking at headspace and EPPICs to be located. Workforce considerations are a catch-22 situation; if you do not have information about workforce and availability workforce, how much does that influence where you put headspace and where you put EPPICs—do you see what I am getting at: how they fit into there?

Ms Harman : In respect of headspace, the underpinning success of the model is the fact that it does not duplicate existing services; it links young people to them. It links into the existing workforce and, as I said, that has been one of the features of its success. There are workforce challenges in mental health, as there are in many other areas of health. As I understand it, Australian health ministers have recently signed off—and I might be corrected on this—on a national mental health strategy and plan, which we will now start to look at implementing with our colleagues in the states and territories. It is a bit of a work in progress but the government has made a number of commitments to increase certain aspects of the mental health workforce. Those kinds of increases and the detail in that is probably better asked in outcome 12, Health workforce capacity.

Senator FIERRAVANTI-WELLS: Issues such as fly-in fly-out workforce—

Ms Harman : No, in terms of numbers of increases in—

Senator FIERRAVANTI-WELLS: In terms of numbers; not dealing with the issue, as such. My point is, there are real workforce issues here. In the bigger picture, will they be part of what you are looking at in the 10-year plan?

Ms Harman : One of the pieces of feedback that has come very strongly to us, through a number of consultation mechanisms we have in place to inform the drafting of the road map, has been workforce so I think it is something we cannot ignore.

Senator FIERRAVANTI-WELLS: I notice in some answers to questions on notice, on headspace, the criteria used to determine the location of the first 30 sites is different to the criteria that will now be utilised. Thank you for the information on that. What about the location of these sites, given the criteria has been revised? Under the original, there was an application type process. Now there is a different way of deciding. What has been the basis of that change and what criteria will the minister use in determining where the remainder of the headspace sites will be located?

Ms Harman : There have been three phases of headspace and we are about to enter into the third one. The first phase was very much a start-up. The selection criteria, as you indicated, and as we put in our question on notice, were quite specific and headspace went to market for lead agencies and backed winners—backed those people who put their hands up and said 'yes, we are wanting to give this a go'. I think that is a reflection very clearly of the fact that it was an organic process at the beginning and something that reflected the fact that the headspace model was starting up.

The second phase, which was announced in the 2010 budget, where the government gave some additional funding to expand the number of headspace sites, then took a more strategic, if you like, approach to the selection of sites—building around the locations that were already operating—and took into account the factors that we outlined in our question on notice. As we enter into the third phase, where we are seeing a significant increase again in the numbers of headspace sites around the country—up to 90 by the end of 2014-15—the government has asked the department to do some far more scientific modelling that uses a population based approach, using population data from the ABS and then with socioeconomic weightings and so on to inform its decisions around what that national rollout should look like.

Senator FIERRAVANTI-WELLS: Are we shifting to a role now for the states and territories?

Ms Harman : We have consulted with states and territories. The department did the initial modelling and then had a number of bilateral conversations with states and territories where we tested the findings of the model and also sought advice to add a level of human intelligence to that modelling, to take into account local factors like how young people travel, where they hang out, local readiness, infrastructure and other state services that could link in. The feedback that we received from states and territories broadly confirmed that the results of the modelling were spot on.

Senator FIERRAVANTI-WELLS: It is not like epics, where there is the contribution of states and territories. Your consultation with the states is purely one of information gathering and framework and stuff like that.

Ms Harman : It was to test whether or not the model had produced the right locations.

Senator FIERRAVANTI-WELLS: Understood.

Ms Harman : It was a very useful process, which did result in some changes to the phasing, for example, of some of the recommendations where future sites should be located.

Senator FIERRAVANTI-WELLS: Obviously you are at a point now where you have a company running headspace. Are we going to see headspace shifted to 'control' by the Commonwealth? Is this now the next dimension in your phase 3? Are we starting to see, under this new model, that it will come under the Commonwealth umbrella? There have been issues about governance associated with headspace and I do not want to traverse those but suffice to say, is this the gist of where the Commonwealth is going, in controlling headspace?

Ms Harman : As I understand it, there are no proposed changes to the governance and funding arrangements. Those have been very stable since around 2009, when the company structure was introduced. The company is operating extremely effectively. It has a very sound governance structure and the board is working very well. We have a very close relationship with headspace, and we have no issues around any of that.

Senator FIERRAVANTI-WELLS: Does that mean the decisions about where they will be located are basically up to the government? Once the locations have been selected, will you then go into a tender type process?

Ms Harman : That is exactly right. The previous process will be repeated. The final decision on locations has always rested with the Commonwealth, but that process has been done in very close consultation with the headspace board. As I indicated earlier, there has been a series of consultations with states and territories to test some of our thinking. Ultimately that is a decision of the Commonwealth. Following that final decision of the Commonwealth as to the next tranche, headspace will do what it normally does, which is to put out an expression of interest process to select lead agencies, and that will be a merit based process.

Senator FIERRAVANTI-WELLS: I will move on to EPPICs. I notice that in your answer 103 you say: 'Subject to negotiations with states and territories on co-contribution ...'. My question was: when will they be up and running? Where are we at with that? What happens if the states do not want to come to the party? I have asked this before, but on this occasion I am hoping for a more constructive response.

Ms Harman : You did. There has been progress. We have had consultations through the senior officials group, which the secretary chairs, and we are considering the results of that feedback. We are still on track to have a national partnership in place with states and territories by the end of the first quarter of next calendar year—so March next year. Through those consultations, the states and territories have indicated a strong interest in partnering with us. They have confirmed that investing in early intervention in youth psychosis is well justified. We will be going through the formal processes.

Senator FIERRAVANTI-WELLS: My question is: if the states do not want to play ball, at what point will you decide that you either have to abandon your commitment or pay for them out of the Commonwealth fund?

Ms Harman : That is a hypothetical question. We are nowhere near that. As I said, the states are indicating—

Senator FIERRAVANTI-WELLS: You are not at that point yet; I accept that. I now move to questions about beyondblue. There has obviously been a lot of media attention on mental health issues lately, Ms Halton.

Ms Halton : Yes, there has.

Senator FIERRAVANTI-WELLS: Professor Baggoley, from reading the AAP wires, I understand that you were seeking a full explanation from the organisation's board regarding the internal matters. Is that report correct? I understand that you were attending the annual general meeting.

Prof. Baggoley : Correct. A number of areas of concern were raised by me in writing to the acting chief executive of beyondblue. I have requested a detailed response, in writing obviously. The Commonwealth—with all jurisdictions who are members of the board; not directors of the board—attended the AGM yesterday, and these areas were raised by me at the AGM. The answers provided at that stage were satisfactory. But of course we are waiting for the written response. The beyondblue board issued a statement, which I can table if you wish. It has been issued today.

Senator FIERRAVANTI-WELLS: Can you take this on notice: how much money does beyondblue get from the Commonwealth? There was an answer which pertained specifically to suicide prevention.

Ms Harman : I can answer that now. It receives $60 million from the Commonwealth over four years; that is, for the period 2010-11 to 2013-14.

Senator FIERRAVANTI-WELLS: Could you provide me on notice with a breakdown of where that is?

Ms Harman : Of course.

Senator FIERRAVANTI-WELLS: I will look at that and put some further questions on notice. Tell me a little more—or take it on notice—about suicide black spot funding. Where has that $277 million announced at the last election gone? I know there has been some re-allocation. In I think 194 you answered—

Ms Harman : Over the period, as a result of the adjustments and redirections made in the budget over the period 2011-12 to 2014-15—

Senator FIERRAVANTI-WELLS: Is that the table you provided?

Ms Harman : That is correct. Of the original 15 measures announced, eight are either fully or in part implemented, four are in the process of very advanced implementation planning and three are no longer proceeding, as a result of the budget announcements.

Senator FIERRAVANTI-WELLS: I have more questions on suicide prevention. I will put them on notice. I am determined to finish at a quarter to five. This question relates to e-mental health. You gave an answer to a question by Senator Adams about telephone and online mental support. That is different to the portal. Will you take account of existing e-mental health portals? For example, there is the work that ANU has done with Beacon—those sorts of things. Is it envisaged that you will start from scratch or will you look at what is already in the marketplace?

Ms Harman : This will be a national portal. It will draw together, and provide an easy gateway to access, all those existing online services. The various telephone counselling and web-based support organisations such as the ones you have just mentioned are continuing to be funded by the Commonwealth. Over the next five years 64.31 will go to those organisation to continue those services. The portal will create an umbrella of access to all of those and a range of other initiatives. In that sense we are not wanting to re-invent the wheel; we are wanting to create one place where everybody can go to and get either self-drive help or to—

Senator FIERRAVANTI-WELLS: That is that $14 million?

Ms Harman : It is $14.4 million. The e-mental health portal will be funded from what has already been allocated to the national health call centre network. Using that money, the national health centre will be contracted to develop the portal. The $14.4 million will fund the virtual clinic and a central support service, which will provide peer support to—

Senator FIERRAVANTI-WELLS: Will it be another pilot? How will you—

Ms Harman : In terms of those other two elements—the virtual clinic and the central support service—we are looking to go to tender I believe towards the end of this year, early next year. These measures will obviously be evaluated in due course.

Senator FIERRAVANTI-WELLS: I put a series of questions on notice about the multicultural mental health project. Is it possible to get a copy of the independent review of the project?

Ms Lowrey : It is on our website.

Senator FIERRAVANTI-WELLS: Sorry, I do beg your pardon.

Ms Lowrey : That has been put on the website but we can get you a copy.

Ms Harman : So that was the Health Outcomes International review. That report was published on the mental health website.

Senator FIERRAVANTI-WELLS: Is that the independent review of the Multicultural Mental Health Australia project?

Ms Harman : That is correct. There were two independent reviews. There was a program and management review which was done by Health Outcomes International, which is the one that is public. Then there was another review that was done into financial management issues which is not public.

Senator FIERRAVANTI-WELLS: That is the one I was interested in in relation to the various questions that I asked. There were a range of issues that were canvassed in relation to the south-eastern, south-western area health service that had had the funding in the past to undertake the project.

Ms Harman : I would have to take advice on that.

Senator FIERRAVANTI-WELLS: Would you take advice on that, even if a redacted version of it could be provided to me. I have a couple of other issues. How is the implementation of the consumer peak body going? I understand there was an announcement made. Obviously with all the things happening with mental health at the moment a body of this nature is really important. Where are we at with that, Ms Harman?

Ms Harman : In terms of the establishment of the new consumer organisation, as you are aware Minister Butler announced on 1 July a decision that the new organisation would be auspiced by an established organisation. The rationale for that decision was to get the organisation up and running as quickly as possible and to create some certainty around its back-end office functions and to create some surety around its sustainability. The minister invited the Consumers Health Forum to be that auspicing organisation.

Senator FIERRAVANTI-WELLS: So Ms Bennett's organisation will auspice—

Ms Harman : The minister invited CHF to be the auspicing organisation. We are in negotiations with CHF in that respect. A meeting was held between the department, CHF and consumers in Canberra on 21 September where a number of issues to clarify the auspicing arrangements and the role that CHF were proposing to play were discussed. Those discussions are ongoing.

Senator FIERRAVANTI-WELLS: I might put some further questions on notice in relation to that. I would like to conclude with some questions about detention and where processing is occurring at the moment in relation to mental health services. I understand that it is outsourced by the Department of Immigration and Citizenship. Does the minister, in his capacity as minister assisting the Prime Minister on mental health issues, have any role at all in relation to mental health issues/detention centres?

Ms Halton : The answer to that is: he does not have any responsibilities because it is a matter for that portfolio. As you are probably aware, because we have canvassed it in respect of other issues in the past, that this department occasionally is asked to provide technical advice to that department. That is usually in respect of what medical conditions may or may not be regarded as relevant in terms of visa applications. It tends to be that kind of advice we are asked for. In terms of the provision of mental health services, you would also know that we recently had torture and trauma transferred to us from that department.


Ms Halton : Immigration is responsible for all aspects of the care and provision of people who in this particular case are in detention.

Senator FIERRAVANTI-WELLS: Could you give me an example of the sort of technical advice you might give?

Ms Halton : For example, if you were thinking of applying to bring somebody to Australia under some sort of a visa—and I cannot do visa numbers for you; it is not my area—

Senator FIERRAVANTI-WELLS: I used to deport people in another life.

Ms Halton : Okay, Senator, there you go! But, say, whether or not the person might have a need for medical treatment that actually is in short supply in this country would be a relevant issue—for example, organ donation. If someone was in need of an organ, that would be something we would say to the Department of Immigration and Citizenship is an issue of short supply and therefore would be relevant to the consideration of whether or not the person should be granted a visa.

Senator FIERRAVANTI-WELLS: Other than that no other—

Ms Halton : No.

Senator FIERRAVANTI-WELLS: What about in matters where the Commonwealth is being sued for post traumatic stress and those sorts of issues for people who have been in detention?

Ms Halton : Not that I am aware of but I will take any correction from the team—the answer is no.

Senator FIERRAVANTI-WELLS: Thank you, Ms Halton.

Senator WRIGHT: I would like to take you back to the issue that Senator Fierravanti-Wells raised about the mental health consumer peak body. I understand you said that there was a meeting on 21 September between the department, the Consumer Health Forum and consumers in relation to that. I understand that about $4 million was allocated to the Consumer Health Forum to establish the mental health consumer peak body. I am interested to know how much of that has already been expended and what has been the outcome in terms of deliverables.

Mr Singh : The $4 million has been set aside but it has not been provided to the CHF. As my colleague has indicated, they are currently considering their participation in the project and obviously we are in contract negotiations with them. They would include deliverables for the project.

Senator WRIGHT: So it has not been provided yet and there are still negotiations ongoing. Is it definitely going to be the Consumer Health Forum auspicing this consumer peak body?

Mr Singh : The minister has certainly indicated his desire to have an auspicing arrangement for the new consumer national peak body, and he has invited the CHF to be that body. But obviously they need to be comfortable about their role, what it will entail and whether they will have the capacity to deliver on the project. So at the moment, as I said, we are currently in contract negotiations and they are considering their position.

Senator WRIGHT: So it is still at a very preliminary stage from what you are saying?

Mr Singh : Yes.

Senator WRIGHT: Is the department satisfied with the progress of the Consumer Health Forum in its role in establishing the consumer peak body?

Ms Halton : I do not think we can be either satisfied or dissatisfied as it is rather early.

Senator WRIGHT: So it is too early to form any kind of view about that?

Ms Harman : Senator, as Mr Singh has indicated, we are currently in negotiations with the CHF around the contract. So they are not actually in contract and therefore we are not able to assess their performance against a contract at this stage.

Senator WRIGHT: Have you received any complaints or been asked to address any concerns about the way the process has been handled thus far?

Ms Harman : Yes, there were a number of issues that were raised by consumers and that was the reason the department called together CHF and consumers in Canberra on 21 September. That was an extremely productive meeting; there was a very clear airing of views, a very respectful exchange. People participated in that process very willingly. As a result of that, all parties concerned are going away and thinking about what their involvement is going to be.

Senator WRIGHT: So that does sound productive. Can you tell me what the nature of the complaints or concerns were that were raised?

Ms Harman : They ranged from a fundamental objection to the organisation actually being auspiced—that is a decision of the government and for the reasons that I outlined earlier—through to the role of consumers in the establishment of that organisation. So there were various issues.

Senator WRIGHT: Can I take you back to the first aspect of that—a fundamental objection to the organisation being auspiced. I am just not sure whether you mean an objection to the particular organisation which was chosen, or which apparently will be selected to do the auspicing, or whether it is the process of having the consumer peak body auspiced at all.

Ms Harman : I think there are some consumers that would prefer to see the organisation stand on its own two feet from day one. I do not believe there is anything particular around CHF. Clearly the minister has indicated his confidence in CHF as an organisation that has a strong track record in good governance and establishment, and obviously also sits across the health system so has that broader health experience not just around mental health.

Senator WRIGHT: In terms of the other concern that you indicated has been raised, which is the role of consumers. Could you elaborate on that?

Ms Harman : In respect of an auspicing arrangement, the CHF, were it to accept the invitation of the minister to auspice the organisation, ultimately the board of CHF would be responsible for the outcomes under the contract. If it were to sign a contract with the Commonwealth, the CHF board would be responsible for those deliverables. So there is a degree of tension around the role of a consumer advisory group in respect of decision making around an auspicing arrangement. That would be no different to any arrangement under an auspicing approach. It is not about the CHF; it is about, again, the auspicing idea.

Senator WRIGHT: And the processing?

Ms Harman : Exactly. As I am sure you will appreciate, any organisation or board would ultimately carry the financial and governance risk around a contract with the Commonwealth. So whilst it might take advice from a consumer reference group or advisory group, the decision making would ultimately rest with the organisation and contract.

Senator WRIGHT: Thank you. What is happening with the mental health carer peak body? My understanding is that there is not one at this stage. Is there foreshadowed to be one in the near future?

Mr Singh : The last part of your question is probably an issue for government. You are correct to say that there is not a specific mental health carer body at the moment. We do fund the Mental Health Council of Australia to auspice the National Mental Health Consumer and Carer Forum, which does help to make sure that carers have the capacity to advocate on behalf of their constituents at a national level and enable their participation on some national committees—for example, the Mental Health Standing Committee, which ultimately reports to health ministers. It is also true that there are state carer bodies with whom we engage quite regularly—for example, ARAFMI—and that DOHA currently provides funding to the national body for carers generally in the shape of Carers Australia. We certainly value the role of carers in mental health and there are number of ways in which we seek to make sure that their voices are heard at the national level and are appropriately engaged in the consultation.

Senator WRIGHT: But there is nothing that you are aware of that suggest that there is any kind of planning for a mental health carer peak body at this stage?

Mr Singh : That would be a matter for government.

Senator WRIGHT: Thank you for that. I have another question in relation to the Day to Day Living Program. The National Health Reform Progress and delivery report released in September reports that key National Health Reform milestone No. 4.2 is to expand the support for the Day-To-Day Living Program to meet demand for services. Funding negotiations are due to commence, I understand, with existing service providers in January 2012. Correct me if I am wrong on that.

Ms Nicholls : There are contracts in place with existing services to December 2011. We are in the process of finalising the funding allocation for the additional funds that were made available in the 2011-12 budget and we would be expecting to provide offers to services later this month or early November at the latest.

Senator WRIGHT: Thank you. How many additional people are expected to receive services via this program and when will this occur?

Ms Nicholls : The funding commences from 1 January 2012. It is anticipated that an additional 3,650 people per year would receive services, which is an additional 18,000 over five years.

Senator WRIGHT: Can you explain where that figure came from, because it is about meeting demand for services? How has demand for services been measured?

Ms Harman : We fund the program on a place basis. It is a capped program in the sense that we have a funding allocation and we understand from several years of the program now how that funding is used and how much a place costs. If you are going to ask me how much a place costs, I do not have that figure with me, but I am happy to take that on notice.

Senator WRIGHT: I would appreciate that. Thank you.

Ms Harman : We do have some historical knowledge of how the program behaves and how NGOs that we currently fund—there are about 40 of them, I understand—are actually using those monies. The $19.3 million over the next five years marks a significant expansion of that program and it will allow an additional 18,000 people, as my colleague has said, to be assisted over the next five years.

Senator WRIGHT: How will it be determined that demand is being met?

Ms Harman : It is a capped program in the sense that we do have a limited bucket of dollars. The $19.3 million, as I understand it, will go a significant way to meeting the demand the program in is currently facing. But we will have to monitor how that goes. We are also in the process, as my colleague said, of rebasing the funding so that more funding will be available for service delivery.

Senator WRIGHT: Thank you very much. Thank you, Chair.

Senator FURNER: Can I ask some questions around the new National Mental Health Commission. One of the responsibilities of the commission, as the third dot point of the media release says, is:

Develop, collate and analyse data and reports from a range of sources—with a particular focus on ensuring a cross sectoral perspective is taken to mental health reform;

Would you be able to describe what 'a range of sources' might be in respect of that particular responsibility?

Mr Singh : Obviously, given that the commission starts on 1 January, this will be a hypothetical discussion. But I think I can say that there are a range of existing data sources, including national minimum datasets, where the states provide us with information about services within the purview; there are surveys that the Commonwealth funds on a national level; and we are constantly in the process of developing more surveys and better ways of targeting people's experiences in mental health and finding out more about their journey through the system. So, for example, at the moment there are projects underway to develop some indicators around the consumer experience of care in mental health. The commission I think would be looking at all those sources of information. They are currently published in a range of areas, including a national mental health report and the COAG annual report. The AIHW has a report they put out as well. It is likely that the commission will be looking to synthesise some of that data and fill some of the gaps in the suite of reporting that is currently available. The government has already said that one of the tasks for the commission in this particular area will be to take on the Annual national report card on mental health and suicide prevention. That is very likely, I think, to look at particularly the consumer and carer experience, which is something that is not currently will reported elsewhere.

Senator FURNER: Would one of those sources available to the commission be the good work this committee has done in terms of suicide prevention and some of the inquiries it has been involved in over the past several years?

Mr Singh : I am sure that the commission will be looking at those, yes.

Senator FURNER: It also mentions as one of the responsibilities as consulting with relevant agencies. Would you be able to describe what those relevant agencies might be?

Mr Singh : As the secretary previously noted, the commission is very much intended to take a whole-of-government view, a cross-sectoral view, for mental health given that the needs of consumers and carers in mental health are wider than if they related to health care alone. As a result, the commission will need to engage with agencies like us and FaHCSIA, with DEEWR in relation to employment support, and with states and state agencies on a broad basis.

Senator FURNER: The commission has been provided a budget of $32 million over the 2011-12 budget period. I take it some of that would be spent on marketing or advertising in terms of what the commission is going to do in its forward planning and work.

Mr Singh : The details of the commission's budget and what it is planning to spend its money on is unfortunately a matter for the Department of the Prime Minister and Cabinet. If I could just correct one thing: that $32 million is over five years, not the four-year forward estimates.

Senator FURNER: I would like to ask some questions on mental health in general. There are some good organisations around, like Mates in Construction. When this committee was in Melbourne a few years ago, it heard from beyondblue about the sort of work it is doing, also in the construction industry. Are you able to provide any contemporary data to the committee, particularly in respect of that area of construction workers and suicide prevention.

Ms Harman : Unfortunately, I do not have that detail with me today, but I am very happy to take that on notice. Mates in Construction is a program, from memory—again, I will stand corrected if my colleagues throw something at me—that we funded with the National Suicide Prevention Program. It is a very high-performing program as I understand it. We are happy to take that on notice and provide you with some further information.

Senator FURNER: Thank you. Are you suggesting they are already funded?

Ms Harman : Sorry; I got that completely wrong. I will correct my evidence there. It is not something that we currently fund under the National Suicide Prevention Program.

Ms Lowrey : That is right. We do work with beyondblue though. We have special funding for targeting men in the workplace, and they do do some work in the construction industry.

Senator FURNER: Do they only do it in Victoria, though?

Ms Lowrey : I will have to take that on notice and get back to you.

Senator FURNER: Thank you.

Ms Harman : My apologies, Senator.

Senator FIERRAVANTI-WELLS: I, and I am sure I speak on behalf of other senators, have not asked any questions in relation to the better access program because we have just recently had the inquiry. I have not traversed those sorts of issues, and I will probably wait until the outcome of the Senate inquiry. I just wanted to put on the record the reason we have not asked any questions on that. Senator Moore is nodding and agreeing with me on that one.

CHAIR: On that basis we have finished our questioning on outcome 11, Mental Health. Thank you to the officers.


CHAIR: We will move on to Outcome 6, Rural Health.

Senator McLucas: Mr Butt has an answer to one of Senator Adams questions if it is timely to do it now.

CHAIR: If you would like to put that answer on record, Mr Butt, that would be fine. Which one was it?

Mr Butt : It was an issue raised earlier about the alignment of boundaries between Medicare Locals and local hospital networks. In fact, there is quite substantial alignment of the boundaries across Australia. One of the objectives of the planning that was done at national and state level, and of a lot of the consultations that occurred, was trying to align as much as possible—that was one of the criteria—along with using local government area boundaries. In WA, which you mentioned specifically, in fact the external boundaries of the local hospital networks and the Medicare Locals are absolutely aligned. Even though you have got eight Medicare Locals in Western Australia and four proposed local hospital networks in Western Australia, for example Northwest local hospital network is absolutely aligned with Kimberly-Pilbara Medicare local.

Senator ADAMS: What about the Great Southern down the bottom there? That is where there was some confusion.

Mr Butt : Goldfields-Midwest plus Southwest are absolutely aligned. Their external boundaries are aligned with Southern, so that in planning together those two Medicare Locals can plan with the local hospital network. Then if you go into North Metro, the two Medicare Locals in North Metro— North Metro being the local hospital network—align with North Metro. So, again, the two Medicare Locals can work on the same boundaries as the one local hospital network.

Senator ADAMS: There was one problem with the new health service boundaries with the Kalgoorlie area and Esperance, and I think Esperance and Ravensthorpe were pushed over into the Great Southern area and not into that one, which is really why I asked the question—because it was out of line up there well and truly.

Mr Butt : But the boundaries are still contiguous—even though there are two Medicare Locals their boundaries are contiguous with the one local hospital network, so they can work together and plan together and compare data and do population based planning.

Senator FIERRAVANTI-WELLS: I just want to ask some questions in relation to the Health and Hospital Fund in relation to the regional priority round.

Ms Halton : That is actually not this program, but see what you can do.

Senator FIERRAVANTI-WELLS: Where is it under?

Ms Halton : It is under acute care. The officers have been and gone, so tell us what you would like to know.

Senator FIERRAVANTI-WELLS: My questions go to how much money remains in the fund, expenditure to date, allocation of moneys, contracted projects.

Ms Halton : We will have to take it all on notice. At 9:30 tonight, under Health Infrastructure, at 10.6, the relevant officers will probably be here.

Senator FIERRAVANTI-WELLS: My other questions are in relation to the dedicated unit for rural health services. I am just going back to an announcement in the 2010-11 budget of the establishment of a dedicated unit within the Department of Health and Ageing to provide advice to the public on regional health and aged care matters. Part of the commitment to regional Australia—and this was part of the agreement I think with the member for Lyne, and the member for New England, is it, Mr Cameron?

Mr Cameron : Correct.

Senator FIERRAVANTI-WELLS: This is just within rural health in outcome 6—is it a dedicated unit? How many staff are in that unit? Tell me a little about it.

Mr Cameron : The number of staff in the unit is currently around the high 40s. That is a—

Senator FIERRAVANTI-WELLS: They go bush every so often.

Mr Cameron : No. Because we have had some ons and offs, the creation of the agency itself has effectively subsumed parts of both branches of the previous office of rural health.

Senator FIERRAVANTI-WELLS: Is it a unit or is it one of these executive agencies?

Ms Halton : No.

Senator FIERRAVANTI-WELLS: Just a unit.

Mr Cameron : It is an agency within the department; it is not a prescribed agency.

Senator FIERRAVANTI-WELLS: So it has its own budget?

Mr Cameron : It has a budget in the sense that any unit of the department has a budget.

Senator FIERRAVANTI-WELLS: So a cost—what is the estimated cost of this unit, and is it funded out of existing resources?

Mr Cameron : Yes. There are two components to it: one is the administrative expenses that go to the services programs that it administers; and the other is the departmental staffing and supply costs.

Senator FIERRAVANTI-WELLS: So roughly what?

Mr Cameron : I have them for the year—it might just take a minute to get it in rough terms. The departmental expenditure cost is about $6 million and the administered services program expenditure currently is about $190 million. I can certainly refine that for you, given a bit of time.

Senator FIERRAVANTI-WELLS: You can take that on notice. The annual report talks about providing a single entry point to information on regional health and aged-care programs, policies. Is this a virtual entry point or physical; do you have points in regional Australia where you can go and ask for information like the pharmacies where you had the Medicare points?

Mr Cameron : No, to the latter part of your question. The single point of entry consists of three things: one is a telephone line; the other is a website that uses much the same information as the call centre will provide; and the other is an email function.

Senator FIERRAVANTI-WELLS: So there is no physical location. Have you undertaken any advertising or promotion?

Mr Cameron : No, not yet. The minister is yet to formally launch that.

Senator FIERRAVANTI-WELLS: Just to give me an idea: how many inquiries have been handled since 1 July this year?

Mr Cameron : I can tell you that.

Mr Booth : We will find the exact figures, but they will be minimal; there hasn't been a formal launch of the agency yet, so the numbers will be fairly low.

Senator FIERRAVANTI-WELLS: Perhaps if you could just give me the type of inquiries, albeit limited: is it health services, aged care, referral—the sort of work that has been done to date? Is it intended that you will provide advocacy advice to the government?

Mr Cameron : Advocacy advice within government, I think, is a better way of couching that. The intention is to make sure that, within the policy framework in which rural health exists, key issues are kept front and centre within both our department and where we can with other key decision-making departments.

Senator FIERRAVANTI-WELLS: Is it the intention of the unit to undertake any research on the health and aged care needs of regional Australia?

Mr Cameron : It would probably be more accurate to say that it will be a point of collation for other research. Research in the pure sense is well beyond—but we will be very interested in the outcome of other research and will be looking to establish a fairly substantial reference point, a knowledge base of other research.

Senator FIERRAVANTI-WELLS: So other consultants could be engaged to do research or something like that?

Mr Cameron : Where we are funded for such consultancies, yes, we would be looking to pull together as much of the existing work as we possibly could.

Senator ADAMS: I would like to start off with the Royal Flying Doctor Service and the rural women's GP service. Is that going to continue?

Mr Cameron : I am not quite sure that I understand the question. The RFDS and the rural women's GP service are two different programs.

Senator ADAMS: You fund it get the RFDS to actually run it.

Mr Cameron : So your question is actually about the rural women's GP service?

Senator ADAMS: That is right. I was trying to identify which he was talking about and that was what it was.

Mr Cameron : The rural women's GP service will continue for the next couple of years, after which it will be rolled into the Rural Health Outreach Fund, one of the flexible funds I heard you refer to earlier, but there will be a couple of years before that will take effect.

Senator ADAMS: So it is still going to be continued?

Mr Cameron : Yes.

Senator ADAMS: That is good. A few people have asked me about it and I have said, 'I am sure it's going to continue,' but I will ask the question of the right people, so I have done that. I would just like to come back to the consolidation of the funding programs. There are three concerns that I have been approached about. Firstly, if contestable funds are allocated through competitive tender, how can the most needy communities and small organisations that do not have access to people who can write very good applications for funding be assured of funding so that the programs actually get out to the areas that are desperately in need of funding?

Mr Cameron : In the context of the Rural Health Outreach Fund, it would be important to make a distinction between the management of the program and contestability in that space and contestability for the actual services in particular locations, as you have just described. No matter what we end up with after the guidelines for the fund are finalised, there will be a needs based assessment process that makes a recommendation to the department about where and for what the outreach resourcing should be spent. Under the current arrangements, under the Medical Specialists Outreach Assistance Program, MSOAP, for example, which is one of the component programs—

Senator ADAMS: I am coming to that later.

Mr Cameron : There are advisory forums in each jurisdiction that essentially provide an expert reference panel to both the fund holders and the department. A function that is either that or like that will still need to exist to make sure that locations with need are serviced.

Senator ADAMS: How will the consolidated funds be administered to ensure that the schemes targeted to rural and remote areas to redress poor access to health services and health professional shortages are not diminished?

The reason for asking this question is that possibly coming from Western Australia where we started off with nurse practitioners it has been a worry that a lot of those nurse practitioners originally were hopefully going to go into the more remote areas and, of course, ended up in the city. So the funding has not got out to where it is going. That is just an example of why I am asking this particular question. It worries me just how local the Medicare Locals are. This is where, somehow, we have to get the message through that this funding must go out to those rural and remote areas and not be concentrated on the regional areas.

Mr Cameron : The Rural Health Outreach Fund will be one of the suite of targeted rural health programs. The core eligibility criteria for those programs is that the money is spent where the services are provided in remoteness areas under the ASGC-RA program 2-5, inner regional to very remote. Only in unusual circumstances can targeted rural health funding be spent in a major metropolitan centre. That circumstance would then be that the services are then delivered remotely—where someone's post office box or business office may be.

Senator ADAMS: This is quite a worry for the eastern seaboard, probably because some of the larger regional centres are referred to as rural and they come in under that band. When you look at what they have and what a small community has, they are very different situations. I wanted to check up on how that was going to go. As far as the rural waiting goes for program delivery that will be done under the scaling, so that is targeted.

Mr Cameron : Targeted rural health program eligible for expenditure for ASGC-RA 2-5.

Senator ADAMS: Something that I have been pretty interested in is the national maternity services plan. One of the first endorsements from AHMAC was for the endorsement of the national strategic framework for rural and remote health, so could I ask that question here?

Mr Cameron : About the strategic framework, yes.

Senator ADAMS: This includes objectives and strategies to address access to health services in rural and remote Australia. Signs of success were to include that access to maternity services for women in rural and remote areas is improved, so can you tell me what progress the Australian government can report towards a sign of success? It is on maternity services?

Mr Cameron : We might be at cross-programs here.

Senator ADAMS: Sorry to do this but it does get a bit complicated, trying to work out where it all goes.

Mr Cameron : Just so we are clear, you have asked a question about the national maternity services plan and—

Senator ADAMS: I am asking it because AHMAC endorsed the national strategic framework for rural and remote health and that included the access to maternity services for women in rural and remote areas. I was not quite sure whether it was coming under the national maternity services plan. That was the problem.

Mr Booth : We can discuss some aspects of the national maternity services plan here and—

Senator ADAMS: The main thing is, has there been any progress made and what progress also has been made with the states and territories with funding for maternity units in rural areas to redress the service closures in recent years? This is a huge problem and Western Australia is a great example of it.

Mr Booth : We can certainly talk about the plan. As you are aware, the maternity services plan was launched earlier on this year and I think a copy of it was provided to senators after the last estimates. Where we are getting to with it is there are a variety of different deliverables within that plan—which states are tasked with looking at—at the moment. There is going to be annual reporting against the plan. My understanding is that the first annual report is probably due later on this year. It is probably at that time when all the states have got the plan, done the reporting and then reported back centrally that we will be able to provide an answer to just exactly what is happening.

Senator ADAMS: When do you expect that to happen? What is the time frame?

Ms Appleyard : The plan, as you know, was agreed by AHMAC in November last year, so the first year technically ends in November this year. There is a requirement under the National Maternity Services Plan for an annual report at the completion of the first year. Towards the end of this year we can expect that annual report. Hopefully, it will be endorsed by AHMAC; it is going through the process at the moment. We then expect the annual report to be publicly available. Some of the actions that you are talking about, like the progress the states have made on access to maternity services in rural communities, would be covered under the state and territory responsibilities, and you will see that reported in the annual report.

Senator ADAMS: This question is more or less along the same lines, so please do not go. What progress has the government made on the development of nationally consistent maternal and peri-natal data collections, including by remoteness, that can inform ongoing planning and improvement in maternity services for rural and remote women and their families?

Ms Appleyard : Thanks for that question. We have made quite a lot of progress on that, having signed an agreement with AIHW earlier this year. We had our first board project meeting recently with all of the relevant stakeholders and we have three years for the first stage of that plan on nationally consistent maternal and peri-natal morbidity and mortality data collection. The first thing we have to do is to establish where the gaps are in the data across the jurisdictions. You would be aware that there is some inconsistency, so one of the aims of the project is to see whether inconsistencies exist and to suggest some ways of achieving national consistency in the data collections. So that project has well and truly commenced.

Senator ADAMS: That is good to hear. The government has recently indicated that the Medical Specialist Outreach Assistance Program is being expanded to enable it to support multidisciplinary maternity-care teams in rural and remote areas. Is there any additional allocation to MSOAP in this and also in the out years? Secondly, what is the budget allocation for this in out years for locum support for the existing rural maternity workforce?

Ms Appleyard : What I can say in respect of MSOAP is that, most definitely, there is an additional budget allocation for it. I do not think I have those figures with me at the moment. Mr Cameron may be able to assist. Basically, the Medical Specialist Outreach Assistance Program funding agreements were established towards the end of the last financial year, and we would expect services to start rolling out later this month in some jurisdictions.

Senator ADAMS: What else is being done to help women in rural and remote communities to get access to high-quality maternity care before, at and after the birth of their babies? Do you have any extra programs or any extra funding?

Ms Appleyard : As you would realise, there are a number of actions outlined under the maternity services plan. A couple of them fall within the responsibility of the Commonwealth, such as the MSOAP, the training for procedural GPs in anaesthetics and obstetrics and the extension of SOLS, the Specialist Obstetrician Locum Scheme. There are also projects being undertaken under the auspices of the MSIJC, the Maternity Services Inter-jurisdictional Committee. I can give you an example of a few of those. There is an investigation into access to public antenatal care in a range of community settings. That project is currently underway. A project on the identification of the characteristics of successful community based care in remote locations is also underway at the moment. There are also some specific measures in respect of Indigenous primary maternity care, which are being actioned under the maternity services plan. Also, as you will be aware, in acknowledgement of the distance for rural and remote areas, tele-health services for midwives have been made available as well. Besides MSOAP, these are some of the main things within the Commonwealth's area of responsibility. A number of other actions are the responsibility of states and territories.

Senator ADAMS: You mentioned the locum scheme. How is that going? Are you getting people to take it up?

Ms Appleyard : I would need you to ask that question under outcome 12, health workforce.

Senator ADAMS: Thank you. Medical skills, programs available for maternity services, anaesthetic, minor surgery: that would be workforce as well?

Ms Appleyard : That is right, Senator.

Senator ADAMS: E-health for rural and remote: is that here or in e-health?

Ms Appleyard : Medicare items would be under MBD, which is outcome 3.

Senator ADAMS: I think I have just about exhausted the rural health bits.

Senator FIERRAVANTI-WELLS: Going back to your question, Mr Cameron, in terms of the ambit of what you are doing in health and ageing, are you looking at aged-care facilities in regional and rural areas? That will be purely under aged care—all you do is gather information about health services, aged-care services, so if somebody from Bourke rings up and says, 'I want to find an aged-care facility,' that is the sort of facilitation that you will do. Is that right?

Mr Cameron : Exactly.

Senator FIERRAVANTI-WELLS: You have got a list of facilities and services available in regional and rural areas and you assist people with that information.

Mr Cameron : Depending on what the particular subject is, it is either a list of facilities or the appropriate contacts to refer them to.


CHAIR: I think we have exhausted our questions in rural health. Thank you very much. We will make a start on aged care.

Ms Halton : While the officers are taking a seat can I just say: we have already tabled the list of FOIs on tobacco but I promised to table the facts in terms of things we talked about earlier.

CHAIR: Thank you very much; a couple of senators had an interest in those.

Senator FIERRAVANTI-WELLS: I might just start on some big picture issues. When is the government intending to respond to the Productivity Commission?

Ms C Smith : The timing of the government's response is a matter for government, Senator.

Senator FIERRAVANTI-WELLS: What sort of modelling, if any, is the department doing on any of the 58 recommendations?

Ms C Smith : We are obviously going through a process of careful analysis of all the recommendations of the Productivity Commission and all of the submissions that were contributed to that process, and there are discussions occurring within government on that basis.

Senator FIERRAVANTI-WELLS: If need be, will you go to other departments like Treasury?

Ms C Smith : We are working with relevant departments because of the wide-ranging nature of the recommendations.

Senator FIERRAVANTI-WELLS: Why is the minister having more consultations in the form of these conversations when he has this report? The reason I ask that is because I go around and speak to the aged care sector and it has been put to me that we are having now more consultations when there has been this comprehensive report. Perhaps you could provide some insight into that?

Ms C Smith : I think the minister felt that it was important to hear directly from older Australians and their families; their views of the Productivity Commission's recommendations and of the issues facing older Australians more broadly. So far he has had a number of events around Australia—I think around 16 as of yesterday—and there are more scheduled over the next couple of months. Older Australians have found it a matter of some interest and people are really taking up the opportunity to talk directly to the minister.

Senator McLucas: I understand that they have been very well received.

Ms Halton : Yes, that is my understanding too. I love the Productivity Commission dearly—we all do, though I do think that those reports are a fraction inaccessible to a lot of people. I think the opportunity to actually hear, in a more accessible way, some of the things that are meant by the report—and also to give people the opportunity to have their say about what the Productivity Commission said—is really valuable.

Senator FIERRAVANTI-WELLS: To perhaps raise the more controversial parts of the PC's report. I think on the last occasion that we had this discussion about the PC reports I asked whether there had been, because of the more controversial elements in the PC report, complaints through the complaints mechanism and whether we had received any but I think Ms Smith or one of the officers told me on the last occasion that there had not been too many come through. Is that still the case?

Ms C Smith : I certainly would not say that we are receiving complaints.

Senator FIERRAVANTI-WELLS: I put 'complaints' in the broad context of people using the complaints system or using the complaints framework to basically express a view on the more controversial aspects of the PC report.

Ms C Smith : I think what we are seeing through the conversations, and in other sessions that a number of us have with various people in the sector through a variety of mechanisms, is a huge degree of interest in the report and its findings; a feeling that it is a very well put together, comprehensive report. Themes around access are of concern to older Australians; themes around quality and themes around workforce have come up as themes—and then a variety of particular sectors have views—but I would not have thought that some of the more controversial aspects, around financing for example, have had quite as much of a run as one might expect.

Senator CAROL BROWN: There have forums that the minister has been holding around the country. We have just recently had three very successful rounds in Tasmania. and I was at the Hobart one, which was successful in both in terms of the amount of people that came to put their views forward but also in the discussion that was had. Are you able to provide us with any other feedback as to what issues they are raising and whether those are the same sorts of issues being raised around the country?

Ms C Smith : I think there are probably some common themes, but then, not surprisingly, people in different parts of the country will have particular areas that they focus on. Obviously in rural areas there is a different set of issues than there would be in metropolitan Sydney, for example. We can certainly take on notice to get back with a bit more feedback.

Senator FIERRAVANTI-WELLS: That would be helpful to get some flavour, without necessarily going into specifics, but if there is sort of a sanitised version of the meetings. I understand that they are public meetings and open to the public so there is no reason not to. There would be presumably a report done in relation to each of those meetings.

Ms C Smith : We certainly take records of the issues that are being raised.

Senator FIERRAVANTI-WELLS: I think we have had it with other things like Medicare and other issues. So if that can be taken on notice that I think the committee would find it quite helpful to see the feedback from those meetings that the minister has had.

Ms C Smith : Senator Brown, the feedback I think you are acknowledging from the Tasmania event is typical of others—that people are very positive to be involved and find it a really constructive experience to be able to have that dialogue directly with the minister.

Senator CAROL BROWN: You may have said it earlier, but how many forums will be conducted?

Ms C Smith : There are 16 that have been held as of yesterday, and I think by mid-December 37 events will have been held, but there is also other events.

Senator CAROL BROWN: The number seems to be growing.

Ms C Smith : There are other events that are emerging too. Alzheimer's Australia is also holding some dementia-specific events and some other consumer organisations are organising—

Senator CAROL BROWN: Who is holding those dementia events?

Ms C Smith : Alzheimer's Australia is convening those with some support from the department, and the minister is attending a couple of those himself, but not all of them.

Senator FIERRAVANTI-WELLS: I guess in this year of decision and delivery, Parliamentary Secretary, are we likely to see some decision and perhaps a delivery of a position on this? I am waiting with baited breath.

Senator McLucas: I think you would recognise that the PC's report recommends significant change and that Minister Butler is very keen to make sure that people are very aware of what sort of changes are proposed by the PC. That is why these consultations are occurring—to inform government's response. It is a very wide-ranging series of recommendations that work across government—it is not simply in the ageing section of the health department—so it warrants significant thought, consultation and deliberation before the government will respond to the report. I have no advice about when Minister Butler is going to respond, except to say that he is taking this consultation process very seriously.

Senator FIERRAVANTI-WELLS: The reason I am pushing the issue minister is that Ms Gillard and Minister Roxon before the last federal election did not really talk much about aged care, except to deliver a speech at the Nursing Federation, where Ms Gillard indicated that aged care and ageing would be a second-term priority.

Senator McLucas: That is right.

Senator FIERRAVANTI-WELLS: I am conscious of that timing and also that, clearly, there will have to be some definitive response as the budget process for next year, which is what a lot of the sector is anticipating, is ticking away and, I understand, has probably started already. If some action is not taken soon, it will not meet that budget process. I am only reflecting some of the issues that have now been referred to me, which is why I am asking: are we going to see something by the end of the year? If we do not—

Senator McLucas: I simply cannot answer that question.

Senator FIERRAVANTI-WELLS: Well, I have reiterated my comments for the record.

Senator McLucas: But I think I have explained what Minister Butler is doing and why and how well it is being received in the community.

Senator FIERRAVANTI-WELLS: I appreciate that. I note that these conversations are publicised through the aged-care conversation website. Are they being publicised in any other way?

Ms C Smith : They are being publicised through a variety of means: through the Council on the Ageing, which liaises with its members, and other consumer groups get invitations out to their members. It is very much trying to use all of the local networks to get information out there, but we always ensure that the schedule is on the blog as well, and I think a number of the organisations put it on their websites as well.

Senator FIERRAVANTI-WELLS: But the information is basically web based rather than through any other means—Seniors Week or those sorts of things.

Ms C Smith : I think some of the seniors organisations find that email does not work with all their membership, so they have other—

Senator FIERRAVANTI-WELLS: Some of us still prefer snail mail; I know that is hard!

Ms C Smith : Yes: snail mail, newsletters or whatever the group has found to be effective in reaching its membership.

Senator FIERRAVANTI-WELLS: How many conversations are planned? I think you said there have been 16 to date.

Ms C Smith : There were 37 scheduled between August and the end of the year, but they are the main conversations on ageing with the minister himself. As I said earlier, there are also others organised through Alzheimer's Australia and other groups which are a bit different to that.

Senator FIERRAVANTI-WELLS: I meant the ones with the minister. So the minister has determined where these will be held with the department?

Ms C Smith : That has been a decision of the minister, yes.

Senator FIERRAVANTI-WELLS: He has gone to the 16 meetings and will be attending the 37?

Ms C Smith : That is right.

Senator FIERRAVANTI-WELLS: How many people on average are attending?

Ms C Smith : It depends on the size of the town that they are being held in.

Senator FIERRAVANTI-WELLS: Obviously if you go to the Wesley Conference Centre in Sydney you will get more than if you go to—

Ms C Smith : I think there might have been a couple of hundred at those bigger events in the capital cities. In smaller locations it has been more in the 50 to 70 range. Interestingly, different issues come up depending on the numbers. People feel more comfortable talking about personal experiences where there is a smaller group of people.

Senator FIERRAVANTI-WELLS: For no reason other than to gauge the number, following on from the discussion we had earlier about a summary of those conversations, if you would not mind, please provide me the rough numbers on notice. I would like to just get a feel for how many. So what happens now? You have feedback sessions and then they will be processed?

Ms C Smith : We are gathering the feedback as we go by event, and that is obviously feeding into the process of government consideration. As we have more events, I suppose themes emerge as well. That will all be collated and recorded as we go along.

Senator FIERRAVANTI-WELLS: I would like to know where we are with the accreditation standards. Are those consultations still going? Chair, I have been asking general questions and now I was thinking of going into outcome 4.1.

CHAIR: I think Senator Siewert has a general question.

Senator SIEWERT: In terms of the process from hereon that Senator Fierravanti-Wells was just asking about, and as the PC report said, this is a process of reform that is going to take quite a time. The area of concern is that some of the viability issues that providers have been talking are going to be ongoing during this transformation process. So will how you go from here include dealing with some of the transitional issues ensuring that providers remain viable? I am wondering what happens while we get from here to there.

Ms Halton : The short answer is that we cannot answer that question in detail yet for obvious reasons. But I can tell you that, in the discussions we are having about how you do what you do and when you do it, obviously we are very mindful of those issues. I think we can say with some level of confidence that the industry has been very clear about where they think the fracture points are. It is reflected in the PC report but they tell us quite regularly and whilst there are no decisions yet—

Senator SIEWERT: I appreciate that.

Ms Halton : I can say we are very aware of it.

Senator SIEWERT: So the process will include where some of those key fracture areas are—I think that is a good term.

Ms Halton : Again, I cannot say what the government will do with those but in terms of our discussions about this matter they will not be forgotten.

Senator SIEWERT: Thank you.

Senator ADAMS: The 2011-12 budget included continuation of expansion of the aged care viability supplement for the current financial year pending the recommendations of the Productivity Commission report into aged care. We have already had an answer to that, but my question really is to do with rural and remote aged care providers. What steps have been taken to provide surety to rural and remote aged care providers that the true cost of providing aged care in rural and remote communities will be better recognised in the future? The second part of the question is: what interim steps are in place to ensure that both community and residential aged care providers in rural and remote communities are able to remain commercially viable in the 2012-13 financial year and beyond while the aged care reforms are being established and implemented?

Ms C Smith : I think you have already noted, Senator, that the viability supplement was extended for a further year. Anything for the 2012-13 year and beyond will be a matter of further consideration by government. Regarding what is currently being done, we have a range of programs, as we have briefed you about before, that recognise the particular needs of providers in those areas of Australia. It is certainly an area that has been drawn to the commission's attention at some length in their process, and the government will certainly ensure those areas are thoroughly considered as part of the government response.

Senator ADAMS: Right, because they are pretty concerned about it.

Ms Halton : Yes, we understand that, Senator.

Senator FURNER: Have conversations been held in any rural or remote areas, or in fact are being proposed, to consider those areas?

Ms C Smith : Yes, some of them have been in rural and remote areas. I have not got the full list with me, but I can certainly provide that on notice. There has been a mix of metropolitan and regional locations and there are others planned in those areas as well.

Senator ADAMS: Could we have them when we are not sitting? There have been three that I could have got to but of course we were over here instead of in Western Australia.

Ms C Smith : The minister has obviously got the parliamentary timetable to worry about as well, so yes, they are concentrated in non-sitting periods but sometimes are on a Friday of a sitting week.

CHAIR: Some were on Fridays?

Senator ADAMS: I do not know, but I just looked and thought 'oh blow'. I think we probably had inquiries and just could not get there.

CHAIR: We will adjourn now for the dinner break.

Proceedings suspended from 17:55 to 19:05

CHAIR: We will now reconvene. We will go back into questions of the aged care program. Senator Fierravanti-Wells, in which program do you believe your questions are?

Senator FIERRAVANTI-WELLS: I am going to start in 4.1. Where are we at with the accreditation standards?

Mr Scott : Since we last saw you in May, we have completed a national consultation process, if you like, across each state and territory on the draft set of standards. We have consulted with a culturally and linguistically diverse subgroup of the ageing consultative committee on the draft standards. We received around 65 written submissions. The outcomes of those consultations are currently being looked at by the technical reference group. We have also started discussions with the Aged Care Standards and Accreditation Agency and others about the best way to test the proposed standards operationally before we start looking to finalise them.

Senator FIERRAVANTI-WELLS: What were the main issues in the culturally and linguistically diverse component of it?

Ms Murphy : The culturally and linguistically diverse group were keen to have the standards reflect the needs of the special interest group. We have had representatives from those groups at each of the consultations around the country. We have also had another meeting with them. We have taken the information that they have provided to us on what they feel they require to the technical reference group, and they are currently considering the issues that they put forward.

Senator FIERRAVANTI-WELLS: What is the next step in terms of the timing, Mr Scott?

Mr Scott : The key next step for us is refining the standards in light of the feedback and doing some sort of piloting or operationalising to have a look at how they would work in actual aged care facilities. Thereafter, there will be some important issues for us to look at in terms of the government response to the Productivity Commission report as well as working with the accreditation agency on where the accreditation cycle is at. I do not want to put any time frames around it, because we will want to genuinely have a look at how the piloting goes and where we are at in the accreditation cycle.

Senator FIERRAVANTI-WELLS: Is a sanitised version of that feedback available anywhere? Would it be appropriate for a sanitised version of that feedback to be available? Could you take that on notice, please?

Mr Scott : Yes, we will take that on notice, because we also need to come back to government on the outcomes of the feedback and the next set of standards.

Senator FIERRAVANTI-WELLS: I have questions for the agency but I will keep those till later. In the Auditor-General's report on monitoring and compliance arrangements—this is the section that would deal with the department's comments and response to that report?

Mr Scott : Yes.

Senator FIERRAVANTI-WELLS: There were three recommendations, and the department has agreed to all three. Can you tell me in practical terms where you now go on this?

Mr Scott : Yes, there were three recommendations. The audit office overall were supportive of the work of the department and the agency in the monitoring and compliance of the residential aged-care framework. In terms of the specific actions, we will be going away to look at the service charter—we have already started looking at it. The agency obviously already has a service charter and they will be looking at reporting against it.

Recommendation 2 was around the understanding compliance and noncompliance, and developing a common risk profile. The department already routinely prepares common risk profiles for aged-care homes. We will be adding to that work to pick up accreditation-specific information that the ANAO has identified as well as incorporating that into our whole-of-sector risk analysis. So that will—

Senator FIERRAVANTI-WELLS: Just on that, Mr Scott: in terms of any of the benchmarking that you are doing, is that working parallel to that or you are not looking at benchmarking on that basis?

Mr Scott : The risk profiling we do is within the Office of Aged Care Quality and Compliance and we do a compliance risk assessment of each of our regulated entities. Some of the financial type of information that would be looked at through the benchmarking process we look at as well, but the benchmarking is more a facility for approved providers to be able look at their performance against peers.

Senator FIERRAVANTI-WELLS: I was looking in terms of some of that software that does simultaneous reporting and whether dovetailing those three concepts all in together is the sort of thing, Mr Scott, that you had perhaps given some consideration to?

Mr Scott : The financial information that gets used in the benchmarking we have already accessed to through the general purpose financial report, so, yes, there is dovetailing there but they are two separate processes operationally.

Senator FIERRAVANTI-WELLS: So if I understand, potentially, your risk profile of a home would contain a whole range of criteria. At this point you have not worked that out. You are still working through potentially what that could—

Mr Scott : No. We have for the last 12 months been preparing routinely risk profiles of each of our regulated entities, and it will look at things like accreditation outcomes but also complaints history, compliance patterns, financial performance and the like. Coming out of the ANAO audit, we will be picking up additional accreditation related information. They have suggested that we also aggregate the trends that we are seeing across the individual risk profiles to look at broader sector trends, and we will be building on work on that front to pick up the accreditation aspect.

Senator FIERRAVANTI-WELLS: The Auditor-General's office made comments about obviously the visits of the agency are for a specific purpose. What you are saying is that, once you start putting risk profiles of homes together, you could almost have a narrative and that narrative is updated and is available to be accessed by obviously the appropriate people in the department and in the agency, I would assume, in relation to particular home X or Y?

Mr Scott : Yes. Sorry, I am speaking a little bit on the agency's behalf here as well—and I am sure Mr Brandon will correct me if needed. The agency already has a very well established risk profiling process of its own for its own operations for individual homes, as does the department. We have for some time also cooperated with that risk profiling. Primarily what the ANAO were suggesting here was that there would be further benefits for us if we looked at common trends across the homes to form a more complete picture at the industry level. But what you are saying is quite right. We will continue to develop our risk profiling of individual homes. That already drives quite a bit the visits program of both the department and the agency and we will continue to build on that.

Senator FIERRAVANTI-WELLS: A common example is that I might go to visit a home and they will say they have just gone through their three-year accreditation and then they had three visits in three months or they have had a visit immediately after accreditation and those sorts of things. Is that the sort of risk management you are contemplating? When it is put to me that they have just had their three-year accreditation and been ticked off and then a month or two later they get to visit, I do not quite understand how a visit in those circumstances is necessary in the absence of a specific purpose.

Mr Scott : In terms of those sorts of visits, we would generally not go out unless there was a specific event. For instance, from the department's perspective we would normally only go in if we had received a complaint that warranted an investigation. Likewise, the agency would only go in for some follow-up or a specific referral of a possible problem from the department. But what we do strive to do is make the visit schedule from both the department and the agency sensitive to the level of risk that has been identified.

Senator FIERRAVANTI-WELLS: My interpretation and the way it has been put to me is somewhat different from the rosier picture that you interpret.

Mr Scott : We can always improve our performance and will continue to work on it.

Senator FIERRAVANTI-WELLS: The description used is 'support contacts'. That is hardly how they are described to me at times, but I will not go there at this point.

Senator McLUCAS: That is what they have been called for some time—for many, many, many years.

Senator FIERRAVANTI-WELLS: What I meant, Senator McLucas, was that some of the providers describe them not quite in those neutral terms, as you probably heard when you were the shadow minister for ageing. Mr Scott, do you want to speak on the third recommendation?

Mr Scott : That is around the quality indicators. This is an area that was picked up in the Campbell report. It is obviously quite a challenging area to try and identify meaningful and sensible indicators of the quality of accommodation and care delivery. The technical reference group that is working on the accreditation standards has a remit to also look at the quality indicators. We would also expect that the work will be progressed in conjunction with the work on the government's response to the Productivity Commission report, because it was also obviously picked up in that report.

CHAIR: Senator Fierravanti-Wells, you might want to put some questions on notice.

Senator FIERRAVANTI-WELLS: I have a workforce issue, involving a log of claims to a particular home in Meningie in South Australia. Can I just get some guidance?

Mr Scott : I think it would be better to put that on notice because the name does not immediately spring to mind.

Senator FIERRAVANTI-WELLS: I shall do that.

Senator McLucas: Senator, if it was something that you thought should be confidentially raised you might want to have a chat with me and we will—

Senator FIERRAVANTI-WELLS: It is really pertaining to a log of claims. I think what I will do is raise it and put it on notice. I suspect it is probably best to do it that way. I noticed that the Minister has put out certain media releases in relation to culturally appropriate aged care and conversations with multicultural and ethnic groups. Following on from the comment that was made before in relation to standards—having had an interest in this since my early 20s, which was a considerable time ago—there are obviously, in this area, some parameters that are very different in terms of mainstream aged care delivery and the need to not just be flexible. In dealing with this area, will we be looking at parameters?

Let me just give you an example. I will produce this on notice and give you a copy of these documents. Recently I came across an organisation which receives a considerable amount of money from the Commonwealth to deliver aged-care services. This organisation is promoting—it is in Italian but I will give it to you, it is pretty obvious from the look of it—a political rally, in effect. Their logo is clearly at the bottom of the page and there are other logos at the bottom, including one of another organisation which I am sure gets money from the Commonwealth in some other guise.

In this area, are we going to have to look at dealing with frameworks? Many of these organisations are used to dealing with other governments where frameworks are perhaps not as stringent as our frameworks. I think you get the gist of the question that I am getting to, Mr Scott. Are you bearing those sorts of things in mind when you are having these conversations, looking at frameworks which bring these sorts of issues to the fore?

Mr Scott : Sorry; I must confess that I am not quite sure where you are going.

Senator FIERRAVANTI-WELLS: There are a lot of organisations that operate in this space that do not just operate in the welfare area but also have political overtones, political involvement. Particularly in the Italian community, I can name you any number of them. They are organisations which are mostly politically aligned to the left, but they are politically aligned. They operate in the welfare space but they are also increasingly receiving funds from governments to deliver particular services. When we provide guidelines to them to deliver services in whatever space—whether it be health or ageing—do we make it very clear to them that they are not to engage in party political activities in terms of the use of the moneys that they receive from the Commonwealth?

Mr Scott : That is probably somewhat outside my remit. In terms of the Office of Aged Care Quality and Compliance, our principal focus is around approved providers' responsibility to deliver care. So certainly from the perspective of my responsibilities as a regulator my principal focus will be: are they meeting the accreditation standards and are they discharging their responsibilities as an approved provider? The issue of their involvement in other non-aged-care activities is not centrally relevant to me unless it is somehow impacting on their meeting their obligations as an approved provider.

Senator FIERRAVANTI-WELLS: When we are talking about culturally appropriate aged care, I know that the department gives grants and under the program for community organisations. There are a range of areas in the department where you give moneys to different cultural-called organisations.

Mr Scott : Yes.

Senator FIERRAVANTI-WELLS: My comments are in relation to those broader areas, Ms Halton. It is an issue that has concerned me for some time, but now I will bring to your attention this particular instance which involves an Italian organisation in Sydney. But it is not the only one, and I am sure that it is happening out there. I just want to know from the department's perspective what sort of parameters are in place to ensure that Commonwealth funds are not used in an inappropriate manner.

Ms Halton : Yes, indeed. The thing I can tell you is that funds are to be used for the purpose provided. That is the overarching requirement of any recipient, be they grant, benefit—whatever kinds of moneys. As Mr Scott has indicated, essentially the responsibility of the regulator in the aged-care area is to make sure that services are delivered consistent with the act et cetera. I think the difficulty we have in this area is to what extent you are asking, 'Can we circumscribe the activities of an organisation to just the activities we have prescribed?' Obviously, we cannot do that.

Senator FIERRAVANTI-WELLS: No, but the point I am making—

Ms Halton : So the question is: are they using our cash for that purpose?

Senator FIERRAVANTI-WELLS: Are they cross-subsidising?

Ms Halton : Indeed.

Senator FIERRAVANTI-WELLS: That is really the point I am making in broad terms. I will bring the particular issue separately to your notice, but it is the broader context in which I am asking the question, given it is at a time when it is clear that the minister is having conversations with ethnic groups—certainly according to his press release with Senator Kate Lundy.

Ms Halton : If you put the political activity in a box that says, 'inappropriate activities' you would understand that we investigate across all of our programs where there is an allegation—and it does not matter whether the moneys have been criminally appropriated, just generally misused—we do investigate organisations who are in receipt of our funding. In fact in the past and on occasion we have taken criminal action where it is quite clear that moneys have been used for purposes which are right outside the scope of the grant or whatever.

Obviously we cannot make any comment about the particulars of the circumstance, but the general principle that says, 'You get money for a purpose, use it for that purpose' applies. The act, as you know, is quite clear about that. So certainly if there is evidence that our funding has been misused. You understand probably better than I that many of these organisations have all sorts of sources.

Senator FIERRAVANTI-WELLS: They do, and often they have sources from other governments.

Ms Halton : Yes, exactly.

Senator FIERRAVANTI-WELLS: That is where the line is not very clear. But I guess the point I am making is that increasingly, with the growing need to cater to an ageing population that is ethnically diverse, the Commonwealth, regardless of political persuasion, is going to be facing this issue. I am really asking: in the context of these conversations, are we looking at those parameters as well, bearing in mind that often the requirements of moneys that come from foreign governments do not come with the same degree of stringent—

Ms Halton : Not foreign governments. Are you talking about overseas governments?

Senator FIERRAVANTI-WELLS: Yes, I am talking about overseas governments that may give moneys to these organisations.

Ms Halton : Right.

Senator FIERRAVANTI-WELLS: Take an organisation that has different sources. One of those sources is the Australian government; one of those sources is a foreign government and maybe its own fundraising or whatever.

Ms Halton : I understand.

Senator FIERRAVANTI-WELLS: The parameters that are imposed by that foreign government may be different to the standards that the Australian government imposes.

Ms Halton : Absolutely, and there is nothing we can do about that.

Senator FIERRAVANTI-WELLS: No, there is nothing you can do about that, but they need to understand that we are a bit more stringent in our approach.

Ms Halton : Yes, indeed—and certainly there are circumstances where we have a well-founded view that Australian taxpayers' money is not being used in the way that it is intended. We take that very seriously.

Senator FIERRAVANTI-WELLS: I will leave it there, Ms Halton, but I will provide those details to you.

Thank you for the information provided on notice on the Hughenden aged-care facility. Is this a new model created specifically for this particular facility, or is it a model that is in existence in other places around Australia?

Ms C Smith : It is a relatively new model of care.

Senator FIERRAVANTI-WELLS: We have got some basic information in relation to it. There is a contribution from the shire council and the moneys will be paid to the Hughenden facility? The Commonwealth funding for provision of services will be paid to the Hughenden facility?

Ms C Smith : Yes, that is correct.

Senator FIERRAVANTI-WELLS: Rather than to the council—that was the point that I am getting at.

Ms Robertson : What is happening at the moment is that a funding agreement is currently being prepared between the Commonwealth and the approved provider for the service.

Senator FIERRAVANTI-WELLS: And that funding agreement covers the 'peculiarities' of this particular circumstance, taking into account the involvement of the Flinders Shire Council and the Hughenden operators themselves?

Ms Robertson : Yes.

Ms C Smith : But obviously it is going to cover the terms of our funding to them—

Senator FIERRAVANTI-WELLS: I appreciate that, Ms Smith.

Ms C Smith : and there will need to be separate agreements with the other parties.

Senator FIERRAVANTI-WELLS: Is this an approach that was made by that community to the Commonwealth? How did it come about?

Ms C Smith : It was a decision of government.

Senator FIERRAVANTI-WELLS: So, presumably, take another little community somewhere in regional Queensland, who may have a similar idea: would it would be open to them to approach the Commonwealth with a similar proposal?

Ms C Smith : You will find that different communities and different providers approach governments regularly.

Senator FIERRAVANTI-WELLS: No, that is fine.

Ms C Smith : There is nothing to prevent them doing that.

Senator FIERRAVANTI-WELLS: I am just asking, just like Mr Katter probably did. Thank you.

Senator McLucas: Councillor McNamara has been talking to me about this concept for about 10 years.

Senator FIERRAVANTI-WELLS: I take that back then.

Senator McLucas: It is a well-formed concept that the council had been working on with the community for a very long time. That is why it is a different approach. It is a small community—

Senator FIERRAVANTI-WELLS: I am not commenting. Please do not get me wrong, Senator McLucas. It is just that on the last occasion it was referenced to Mr Katter's involvement. I am glad to see, Senator McLucas, that you have put your involvement in the Hughenden facility on the record as well for the benefit of the good burghers of that area.

I at this point, Chair, have some questions of the agency. I will put the rest of my questions on notice.

CHAIR: Senator Siewert has some questions on community care.

Senator SIEWERT: This morning when we were on disabilities I asked about community care. I would like a quick update, if this is the right place to ask, on where we are going, where are we up to with the changes for HACC.

Ms C Smith : This was obviously agreed as part of health reform in 2010. There are two key milestones. The first was that from 1 July 2011 the Commonwealth would take over funding and policy responsibility for the Home and Community Care Program for older Australians in participating states. At this point Victoria and WA have confirmed that they will maintain business-as-usual arrangements. From 1 July 2012, the Commonwealth will assume direct operational responsibility for the Home and Community Care Program for older Australians. Some very intense work is going on with our state and territory government partners and with the service providers to work with everyone to get them onto Commonwealth contracts by 1 July 2012.

Senator SIEWERT: Does that mean Victoria and WA are out of that process?

Ms C Smith : They will be out of the process of that change to roles and responsibilities. Obviously our existing arrangements with those states to deliver the Home and Community Care Program, which have been in place for 25 years, will continue.

Senator SIEWERT: The process is going on of refining the definitions and reducing the number of different types of funding programs. Does that mean that in WA they will remain the same?

Ms C Smith : The Home and Community Care Program is a joint program between the Commonwealth and the states and territories that provides services for both older and younger people. At the moment it is administered by the states. The funding is shared on a 60-40 basis, with the Commonwealth funding 60 per cent and the states funding 40 per cent, overall. The key change as part of health reform that we are in the process of implementing is as follows. The Commonwealth has agreed to take responsibility for services for the older cohort, and the states and territories have agreed to do so for the younger cohort. Under that arrangement, the funding split becomes more like 70-30. In participating areas—so all state and territories except Victoria and WA—from 1 July 2012, we will directly administer the contracts for service providers delivering services for older clients and the states will administer the funding agreements for the services for the younger clients. In Victoria and WA, the current arrangements, with a joint program administratively run by the states and with a 60-40 split, will remain.

Senator SIEWERT: So there will be no change for providers in Western Australia and Victoria.

Ms C Smith : That is correct.

Senator SIEWERT: And in the other states it will be 70 per cent with the Commonwealth and 30 per cent with the state.

Ms C Smith : Yes. We are working incredibly closely with our state and territory colleagues and with the sector to ensure that the transition process is as smooth as possible—that it minimises regulatory burden for the providers and does not have any impact on service delivery.