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Wednesday, 27 September 1972
Page: 1226

Senator MULVIHILL (New South Wales) - I merely enter the debate to endorse the sentiments expounded by my colleague, Senator Douglas McClelland. Like all other honourable senators who have spoken, I welcome any legislation that can make easier the way in which Australians live a long and fruitful life. As a by-product of medical science life is prolonged and an intensification of services is needed. There might be argument as to the responsibility of the Department of Social Services and the Department of Health as is borne out by the dialogue which ensued between Senator Douglas McClelland and the Attorney-General (Senator Greenwood). That is my opening observation.

If one studies the second reading speech of the Attorney-General who in this chamber represents the Acting Minister for Health (Dr Forbes} and if one looks at the terms of the Bill one sees the recurring phrases 'the Director-General shall' or 'the Director-General will'. This prompts me to ask the Minister, who under the existing machinery is responsible for a multitude of health problems, whether the DirectorGeneral can be as mobile and available as to provide these added services. In a comparison between the European concept of the nation and health and the United States concept I lean to the European and British set-up. I do not deny that in medicine and hospitals the patient-doctor relationship is very difficult. I digress for a moment to point out to people who bleat about how much more can be done by the children of aged persons - I am indebted to Dr Klugman, a learned medico in the other place - that since 1955 family contributions to national health has virtually trebled. In fact, they increased from 1.58 per cent in 1965 to 3.52 per cent of the minimum wage in 1971 so the State must bear a major responsibility for the housing of the aged. The point 1 make in this direction is that 1 remain a little sceptical. If we consolidate some of the functions of the Department of Social Services with others which are the responsibility of the Department of Health and place them under the supervision of a health insurance commission as proposed by the Nimmo report I think we would be dealing with the matter in a much more effective fashion.

Many of us know what happens when we vent a complaint to the Minister for Health (Senator Sir Kenneth Anderson). 1 know the Director-General and his officers. We have seen them before Estimates Committees. We know their diligence but they are only human beings and their work load can only reach a certain point. I am sorry that the Assistant Minister assisting the Minister for Health, Senator Marriott, is not here. He knows of matters which have been ventilated in other fields and the time it takes to obtain answers. I am not cavilling - we ultimately obtain one. In fact, there is a legend - it may not be a legend - that when Senator Greenwood was Minister for Health he was signing 6,000 to 8,000 letters a week. I do not know whether that was so.

Senator Greenwood - 1 would love it to be true.

Senator MULVIHILL - That is probably like a lot of these legends. But this does not alter the fact of the Attorney-General's work load or that of any other Minister. I question part of the Attorney-General's second reading speech which states:

To qualify for the subsidy a home must provide meals and employ sufficient staff. . . . 1 do not know but I imagine thai there will be spot checks on the services rendered. I know full well that when people get over the age of 75 they can be difficult. They can be subject to hallucinations. We all know this. But this does not alter the fact of the proprietary complex. This is bad enough in relation to the private hospital sector today when directors of boards overrule what the matron often believes is the decent thing to do. I say this quite respectfully. Supervision has to remain in relation to these homes for the aged whether they be under denominational control or under the control of some middle group. These standards or services have to be checked. While we are on the subject and talking about the complexities of the various departments there is an important matter which we must not overlook. We all know that when aged people are in nursing homes and we talk about Government subsidies the real nub of the issue is that there can be a considerable chemists' bill which is met by people other than the pensioner. Honourable senators might argue and say that millions of dollars are spent either on nursing homes or on aged persons homes. I believe that if we are to work in tandem there is no valid reason why the Taxation Commissioner should not rule that chemists' bills paid by the sons and daughters of aged people are a suitable item for deduction. There has been a lot of talk in this place about taxation reform. This is one thing into which we do not need an inquiry. This expenditure would not be a debit to social service costs and health services. But this is a vital auxiliary to what we are talking about now.

I return to this matter of supervision. I have some strong feelings about a paragraph in the Minister's second reading speech which states:

In addition a staff member must be on hand at all times in case of emergency.

I qualify these remarks by saying that one cannot get away from the dedication of the bulk of the staff. But what I hope will be avoided is the no man's land where there may be a senior wardsman who has some inner frustration because he is not a Doctor Kildare. The result is that if the opportunity arises he tries to make an onthespot diagnosis. This can be very stupid.

I know of one incident when this happened; I was a witness to it. I hope that under any supervision which goes on - it does not matter who controls the hospital - we will have a far greater frequency of on-the-spot investigations. I do not necessarily blame the matrons at all. But at a time when the general practitioner is squealing to high heaven about doctors not being fully utilised if we are giving subsidies as a natural corollary it is time that the Minister had talks with the Australian Medical Association. The other night on television I saw a doctor who said that it was a luxury not to be called out at night. Doctors are not the only ones who are called out at night. Plenty of people in other fields such as loco enginemen, fire brigade employees and policemen are called out in the middle of the night. Plenty of parliamentarians, too, are out late at night. With all due respect to what is in the Bill I sincerely hope that the AMA will be told that it has a responsibility. In this community, whether you be a parliamentarian or a medico, no-one has a god-like profile. All are subject to supervision. Like all other speakers I know that this Bill has a lot to commend it. But we are a little apprehensive about the machinery of the Department. Is it in a position to check on any blurred spots to see that justice is done? We all know that the field of health services is expanding. A long while ago when Senator Greenwood was Minister for Health or even in the time of his predecessor I suggested that if we did not want to follow completely the Nimmo recommendations then we should look at the position in central Europe, in Belgium and Holland. Somewhere between the board of a hospital or a nursing home and the people there should be participation by the relatives of the inmates. I am not getting onto the worker-management concept but in Belgium there are many checks and balances whereby the bureaucrats and the hospital board are not able to dazzle people with their silence. Having said this and expressed reservations I know, with Senator Douglas McClelland, that we want to accelerate the legislation - mindful, however, that there is always something better to achieve in the distant future.

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