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COMMUNITY AFFAIRS LEGISLATION COMMITTEE
02/06/2010
HEALTH AD AGEING PORTFOLIO
Aged Care and Standards and Accreditation Agency

CHAIR —I welcome officers of the agency. You see: this time we did get to you. I know Senator Fierravanti-Wells has some questions. Other people may as well, but we will go straight into it. Would you like to start, Senator?

Senator FIERRAVANTI-WELLS —Thank you. You were present when I asked questions in relation to the two nursing homes that were the subject of these reports. When was the Bupa one last accredited?

Mr Brandon —The Bupa home was last accredited in September 2009.

Senator FIERRAVANTI-WELLS —And what about Domain?

Mr Brandon —Domain was last accredited, a site audit was conducted, in September 2009.

Senator FIERRAVANTI-WELLS —So both in September 2009?

Mr Brandon —Correct.

Senator FIERRAVANTI-WELLS —Since then, have you undertaken visits to them?

Mr Brandon —We have.

Senator FIERRAVANTI-WELLS —How many in relation to each?

Mr Brandon —We undertook a visit to the Domain home in March of this year and we undertook visits to the Bupa home in April of this year.

Senator FIERRAVANTI-WELLS —With regard to the allegations that were contained in the Daily Telegraph article, did any of the matters in relation to either or both of those homes come to your attention? Did you become aware of or see any of that?

Mr Brandon —No. The concerns raised in the media report had not been reported to us, nor did we have any evidence of them at the time. I should say to you that in looking at the media report on Sunday I think I shared everyone else’s concern about those reports. Quite early on Sunday I created review audit teams to ensure that we were out there quite early to understand and to see what was actually happening in those homes. You would also appreciate that, as a statutory decision maker in relation to accreditation, I am required to deal with the facts, so it is very important to us that the teams we sent out there actually ascertained what was really going on in those homes.

Senator FIERRAVANTI-WELLS —I understand that. In terms of unannounced visits since, there was an announcement made that this government would undertake 7,000 unannounced visits. Are you meeting that target? You obviously go in for accreditation purposes but what about unannounced visits? What is your rate in relation to those?

Mr Brandon —My understanding is that the government announcement reflected previous announcements that each home would receive at least one unannounced visit per year. We have previously achieved at least one unannounced visit per year to each home and we will do so again this year.

Senator FIERRAVANTI-WELLS —That is 2,795 nursing homes, roughly, so that is 2½ visits over the year I suppose. Some get more; some get less.

Mr Brandon —That is true. As you would be aware, accreditation has a cycle. The workload is not flat. Over the three-year cycle, in some years 1,500 homes will get a full site audit. The cycle directs our workloads.

Senator FIERRAVANTI-WELLS —You may have heard earlier some questions in relation to accreditation standards for food. Can you tell us a little bit more about that. I would like to ask you some questions about some of the circumstances that have been put to me and ask you to comment on them. I read some time ago about the involvement of the New South Wales food standards. Can you shed any light on that or is there some involvement by state bodies in terms of food standards in nursing homes?

Mr Brandon —Yes, there is. I can tell you that the residential aged-care accreditation standards that we use relate to nutrition and hydration, but the issue of food also covers a number of other areas, such as regulatory compliance, which I think goes to your topic. In the last financial year we identified 40 homes with noncompliance in nutrition and hydration and in the year to date we have identified 19. Those are the numbers. That is about nutrition and hydration. In fact, as I said, the food area covers other parts. My colleague Ms Crawford is the expert on—

Ms Crawford —Food!

Mr Brandon —She is more expert than I am on the particular assessment arrangements.

Ms Crawford —In terms of your question about state involvement in food regulation, there is a food safety regulation act in New South Wales. Indeed, there are Australia-New Zealand standards that all states comply with, but are administered by each state. The residential aged-care homes come under those acts. In terms of food safety, hazards in the preparation of food, premises and equipment, those standards do not really go to nutrition and hydration, although there are aspects of the standards that deal with the food that should be prepared and provided to vulnerable persons.

Senator FIERRAVANTI-WELLS —Let me just put a circumstance to you. I visited one nursing home where they told me that they used to take the residents on a trip once a week and they would stop at McDonald’s and get an ice cream. They now tell me that they cannot stop at McDonald’s. That is, they can stop at McDonald’s but only those people who are able to go in and get their own ice cream at McDonald’s can partake in this. Those who are not capable of actually going into McDonald’s to purchase their ice cream cannot partake of McDonald’s icecream. Can you shed some light on that?

Ms Crawford —Only to the extent that that viewpoint or application is not part of the accreditation standards. It would seem to me that it is an interpretation somebody has based on the section of that act on food for vulnerable persons. It is not something that we—

Senator FIERRAVANTI-WELLS —Gosh, I am really vulnerable; I eat so many of them! So, in other words—

Ms Halton —We would quite like the details of that. If you would like to give us those details separately, I would be grateful.

Senator FIERRAVANTI-WELLS —I will give you the details, but I want to understand the framework of the food standards because this is a registered nursing home with some patients suffering from dementia. I want to understand who regulates what they can and cannot eat. That is the question I want to understand, Ms Crawford.

Mr Brandon —Maybe I could contribute to this. No-one actually regulates what they can and cannot do eat. In terms of standards there are a whole lot of assessments which would include infection control. In fact, your scenario would include choices and decision making and a whole range of standards. I think Ms Halton has got it absolutely right. If we have all of the circumstances we would then be in a position to ask, ‘Does this meet the standards generally?’ I am speculating but I think the picture you paint could—and I stress ‘could’—cover a raft of standards. In fact, in some ways you might say it has little to do with food per se but is more about a range of other things such as privacy and dignity, choices and decision making. It goes, fundamentally, to the value base and how the nursing home works with, treats or deals with its residents.

Senator FIERRAVANTI-WELLS —I hear that, but look at this article. Who is responsible? There is obviously an issue about nutrition.  Ms Halton made the comment that some people who cannot eat properly have to have their food mashed. I would like to understand who regulates foods, and who is responsible for this in nursing homes that receive subsidies from the Commonwealth government.

Ms Halton —We should be really clear about this. As we know, Food Standards Australia is in the portfolio and I chair the Commonwealth-state regulatory committee in relation to food. For issues in respect of the safety of food hygiene and things of that sort there is a national code. But the delivery of the specific regulatory side of safety, which can go to storage, preparation, et cetera, is a matter to be administered locally, that is, not by the Commonwealth and not by this agency. Nutrition and hydration concern adequate food appropriately provided. Some people need things which are easy to swallow. These are things we have already discussed in these estimates. As Mr Brandon said, there are issues in respect of choice. This particular case sounds as if someone has got the wrong end of the stick. But we need the details so we can have a look at it.

Senator FIERRAVANTI-WELLS —For example, somebody wants to bring food to a resident in a nursing home. What are the rules in relation to that?

Mrs Crawford —There are no rules as such within the accreditation standards. As Mr Brandon said, things like choice and even cultural issues come into it. If the food is brought in and it is handled appropriately, then there would be no issues. Homes would have systems in place for that to occur.

Senator FIERRAVANTI-WELLS —Here is a question. I go and visit a person in a nursing home. I bring them a birthday cake or something that I have made myself. This is a situation that happened to me recently. This resident said, ‘Oh no, we are not allowed to take food from outside.’ I thought perhaps it was the way I made the tiramisu—my mother made it. It was a distinct impression for this resident, whose faculties were 100 per cent, that she could not take this food because the nursing home did not allow them to have food brought in from outside. My question is: in those circumstances do I have to go to the front desk when I arrive at that nursing home and say, ‘I’ve got a birthday cake for Mrs Bloggs, can I bring it into the nursing home?’ That is what I would like to understand.

Mrs Crawford —There is not requirement for that to occur. An individual home may make such a rule. If our assessors were then assessing that home and were aware of that rule, they would certainly ask questions about the choice the residents have. But there are safety issues around food that may be prepared externally, particularly if it is cooked food. Perhaps questions could be raised about the temperature it has been kept at, in order to ensure the residents are safe.

Senator FIERRAVANTI-WELLS —Who determines whether that food can be brought into that nursing home?

Mrs Crawford —It is not a matter of who determines it. It is going to be individual cases each time. There is no rule that says that food cannot be brought into a home.

Senator FIERRAVANTI-WELLS —It is just that I have had other instances. For example, other places have said, ‘We can’t give them strawberries or lettuces any more because of food standards.’ This is the sort of thing that is being told to me. I see these sorts of reports in the paper and you say to me, ‘Look, you can serve anything.’ I go out into the field and I get told that you cannot give residents in nursing homes certain things. There is a discrepancy.

Mr Brandon —We did not say that you can serve anything. In fact, that would be quite irresponsible of us. What we said is that there are a whole range of standards. There is a general perspective about the home-like environment. But, in deciding how these things happen, there are standards about taking into account and respecting cultural differences. We did not say you can give them anything.

Senator FIERRAVANTI-WELLS —I will not press the point. Can you provide for me anything related to food standards applicable to residential nursing homes that the Commonwealth provides funding to? Do you understand my question?

Mr Brandon —I understand your question, but I think it is outside my remit.

Senator FIERRAVANTI-WELLS —Who do I go to? Who is going to give me this information? You say that they do not serve just anything, but somebody should be able to answer this question.

Mr Brandon —I can tell you what we look at when we assess the accreditation standards which have any link to nutrition and hydration, any link to food. I can ask other people about the relevant statutes. I am happy to do that. But I cannot guarantee that it is the world’s best information because that is not our area of expertise. We assess performance against the standards which take into account nutrition and hydration, as I said earlier. There are a lot of other links to other standards.

Senator FIERRAVANTI-WELLS —I am no clearer on the issue than I was. What is the highest number of complaints made about a nursing home in the last three years in New South Wales?

Mr Brandon —You would have to ask that question of the Department of Health and Ageing. We do not action complaints.

Senator FIERRAVANTI-WELLS —I was told that I could ask you.

Ms Smith —The department administers the complaints investigation scheme. I would have to take on notice the question about the highest number of complaints received about a New South Wales home.

Senator FIERRAVANTI-WELLS —Could you do that and give me the details of that? What about the total number of complaints made against nursing homes in New South Wales in the past three years? Could you take that on notice as well?

Ms Smith —Absolutely.

Senator FIERRAVANTI-WELLS —Could you tell me how many have been investigated and the outcome of those investigations. Could you also tell me about the spot checks, the unannounced visits, in the last three years and the procedures that you normally follow in relation to those spot checks. Clearly, the nursing homes are not warned when you make an unannounced visit. I presume you just turn up at nine o’clock in the morning or one o’clock in the afternoon and say, ‘I’m here’?

Ms Smith —Unannounced visits are done by both the department and the agency. The department does unannounced visits in respect of complaints. The agency does—

Senator FIERRAVANTI-WELLS —Then can I ask the question for both—for the agency and for the department.

Mr Brandon —I can confirm that they are truly unannounced.

Senator FIERRAVANTI-WELLS —Where are we at with the accreditation review?

Ms Smith —The department is taking the lead on the accreditation reviews, but we are working very closely with our colleagues in the agency. There are two reviews. One is a review of the accreditation standards and one is a review of the processes that underpin the standards. I gave you a bit of a brief on both at the last hearing. In respect of the accreditation standards, we have engaged PricewaterhouseCoopers to assist the department in undertaking the review. We are also working with the technical reference group. As I said, the agency and the department are closely cooperating on that piece of work. We expect to have a draft set of standards available in the next month or so that will then be the basis of consultation with the sector and piloting later in the year.

Senator FIERRAVANTI-WELLS —There were some reports, which you would be aware of, in relation to malnutrition levels in nursing homes. The last one came out from a Melbourne university.

Ms Smith —There have been a couple of university studies that have been published in the media.

Senator FIERRAVANTI-WELLS —You have taken those on board? You are obviously aware of them. What action have you taken? Have you followed up? Have you taken any action in relation to those reports?

Ms Smith —When we see a report like that, staff in the department—principally our senior nurse adviser—review the study in question. We take that information into account as part of the work we are doing in other areas.

Senator FIERRAVANTI-WELLS —From recollection, that Melbourne report—I think it was Melbourne university or one of the Melbourne universities that did it—was quite explicit in terms of levels of malnutrition in nursing homes. They were very serious circumstances. Obviously, Mrs Crawford is concerned about nutrition; it is clearly an issue for you. Do you measure nutrition levels as part of the accreditation process, Mr Brandon?

Mr Brandon —No, we do not measure nutrition levels. We look at the standards which we expect will stop malnutrition actually happening. In relation to your question about the research project out of Melbourne, we too have reviewed that report and others and what we do is look at the issues that they have raised and then introduced it into our assessment methodology, because that is where a lot of the learning comes from.

Senator FIERRAVANTI-WELLS —When you say you introduce it into your assessment methodology, do you mean you decree that ‘these are the foods that are required to reach a certain nutritional level’?

Mr Brandon —No. When I say we put it into our assessment methodology, I mean that we look at what they are saying are problems, and that gives us hints to look for where those problems are, if they exist in the broad. One of the things that came out of, I think, the Melbourne one that you raised with me last time, was that it was a very small number of homes, and the challenge for us is to ascertain whether the results of that small survey roll out across the sector, given that the sector is very diverse with 2,800 homes.

Senator FIERRAVANTI-WELLS —Mr Brandon, when you walk into a nursing home, like you walked into Domain and Bupa in March and April, how do you ascertain that the residents are receiving the requisite nutrition, apart from looking at them? What do you actually do, Mrs Crawford?

Mrs Crawford —We do a variety of things.

Senator FIERRAVANTI-WELLS —Because that is obviously what is being complained about in the papers here. What are you actually doing to make sure that stories like this do not appear in the newspaper?

Mrs Crawford —In terms of assessing the accreditation standards, nutrition and hydration is about residents receiving adequate nutrition and hydration. That is the expected outcome. We look at whether or not homes are undertaking assessments of residents when they come into the home to ascertain whether at that point they are suffering from malnutrition, because some residents come into a home already suffering.

Senator FIERRAVANTI-WELLS —Yes, I appreciate that.

Mrs Crawford —Then, in terms of ensuring that those residents who are either already suffering malnutrition or at risk of malnutrition are looked after, we look at what food program they may have in place. But that is also coupled with: what does this resident really want; what are the preferences for that resident? We talk to residents, because we want to see whether or not they are satisfied with the meals they receive and with their input into the types of menus that are available. We look at the variety of food that is on the menu. We observe food actually being served to residents and how residents are assisted if they cannot feed themselves. We look at weight loss—and weight gain—so that we can then track what is happening to a resident who is suffering weight loss: has the home realised this, have they referred that to the resident’s GP, has the GP had any input into what should be done with that resident? Are the residents on supplements? How frequently are drinks made available to residents? How easy is it for residents to get additional food and drink when they require it, or do they have to just wait for someone to come along and give it to them? If they say they are unable to access water et cetera themselves because they are too frail, then we look at how frequently the staff are offering them additional drinks. It is a range of activities; it is not just a one-off.

Senator FIERRAVANTI-WELLS —I appreciate that, Mrs Crawford, and may I hope that next time we do not have another story like this one to begin our estimates. That is enough. I do not have any more questions.

CHAIR —Any other questions under accreditation? Senator Adams.

Senator ADAMS —I would like to ask a question about increasing business efficiency in the new provider benchmarking system. Is that going to be linked to accreditation standards?

CHAIR —Thank you to the officers of the agency. Dr Cullen, could you please answer Senator Adams’s question.

Senator ADAMS —It is not linked at all?

Dr Cullen —No, it is not linked to accreditation. It is not about quality of care; it is about business practices.

Senator ADAMS —I would have thought that, with a benchmark, surely your accreditation standards people will have to look at that as well.

Ms Podesta —This is a tool that will be available for the aged-care provider to use to benchmark themselves against other like businesses, to be able to identify their costs, to compare themselves with other like businesses and to identify opportunities for efficiencies and improvements. It is not linked to their accreditation standards; it is linked to their capacity to manage effectively and efficiently within their envelope of money. They may choose to use the information that they gather from that exercise to contribute to the documentation they provide as part of accreditation, but that is not the intention. This is absolutely a service being made available to the industry as part of ongoing efforts to improve efficiency.

The other part of the measure is about not just the benchmarking tool but business advisory services that providers will be able to work with to improve the efficiency of their businesses. It is not meant to be in any way a punitive measure; it is meant to give them an opportunity to improve and increase their own efficiency. We think it is in everyone’s interests that aged-care providers operate efficiently.

Senator ADAMS —I am not disputing that one bit. I think it is very important too, but that particular issue is a benchmark. Surely accreditation people can use that to see where things are going.

Dr Cullen —Fundamentally, accreditation is about the quality of the care delivered. This benchmarking survey is not about the quality of the care but about the cost of delivery of the care.

Senator ADAMS —Surely there has to be a tie-up with it. You are running two things side by side. There must be some alignment that crosses over. We are only going back a few years to when accreditation first started in an aged-care facility, and I was involved with that. That was part of the business side of the accreditation. They looked at it to see how they were performing, what they were doing and what could be done better. Is this not an opportunity to improve that?

Ms Podesta —I think many approved providers will take the opportunity to use that data to improve their own activity and operation and to make themselves more efficient, but the department does not intend to use the benchmarking tool as a formal part of the accreditation process.

Senator ADAMS —That is the answer. Thank you.

CHAIR —I thank the officers from outcome 4, Aged Care. We will now take a 10-minute break. We will come back on outcome 5, Primary care.

Proceedings suspended from 3.59 pm to 4.10 pm

CHAIR —We will reconvene in outcome 5, primary care. Senator Fierravanti-Wells, have you given me any idea about the time for the agency yet?

Senator FIERRAVANTI-WELLS —I think it will just be 15 minutes at the end.

CHAIR —On that basis, we have got two hours. I suggest that we do the first hour and three-quarters on primary care, working as closely as we can through the dot points. But we are very flexible. We can spend the last 15 minutes on the general practice education and training agencies. Senator Fierravanti-Wells, do you have questions on 5.1, primary care education and training?

Senator FIERRAVANTI-WELLS —Ms Halton, what is the Grant Saves exercise?

Ms Halton —Can you give me more information? What are you reading from? That might help me.

Senator FIERRAVANTI-WELLS —I am reading from a document and I am asking you about an exercise referred to therein as ‘Grant Saves’. Does that ring a bell?

Ms Halton —Not in those terms.

Senator FIERRAVANTI-WELLS —I might ask it in other terms. At page 32 of the yellow book, you will see in the middle of the page that it says ‘Department of Health and Ageing Grant Programs - Reprioritisation’. You have got a series of programs in various areas. There are three here, 5.1, 5.2 and 5.3, which are clearly savings measures or moneys that are being shifted or moved around. Specifically in relation to 5.1, 5.2 and 5.3, what are those figures and what does that ‘reprioritisation’ mean?

Ms Halton —We can go through those in the individual programs—I am happy to do that—but you would be familiar with the notion that in each budget sometimes moneys are underexpended or whatever, so—

Senator FIERRAVANTI-WELLS —I appreciate that. I am interested in the actual program. Let us start from the beginning. At 1.1 there is obviously going to be $80,000, $162,000, $249,000 and $252,000 taken out. It goes down the line. I would like to know those programs that are going to have moneys moved and where those moneys are moving to. I will start with that question in relation to 5.1, 5.2 and 5.3. In 5.1 moneys are being reprioritised. Can you tell me what that is in 5.1? It is primary care education and training.

Ms Halton —I have been advised that we are going to have to go through the folders if we are going to go through this line by line and actually sort a couple of things out, so can we come back to this?

Senator FIERRAVANTI-WELLS —I am happy for you to take the table and then give me the answer on notice if you would. I would like to know where the money has been taken out of and where it has been redirected to or whether it has been taken out because it has been discontinued. It is very difficult to understand what it is from that perspective. I have one other question. I am going to start questions on GP superclinics but before I do that—that being an area where the government has obviously made a series of commitments—and of course there were election commitments that we talked about earlier in the day, Ms Halton, does the department provide the minister with regular updates on the progress of key initiatives including election commitments?

Ms Halton —The department provides updates on things that we are doing, programs that are being implemented et cetera. I would not describe them as being ‘election commitments’ but certainly with the programs we are implementing we would advise as to progress.

Senator FIERRAVANTI-WELLS —You are saying that you do not provide regular updates in relation to key initiatives including election commitments.

Ms Halton —No, there are updates in relation to progress writ large.

Senator FIERRAVANTI-WELLS —Which do include election commitments.

Ms Halton —Which include anything that we are working on which by definition can well include election commitments.

Senator FIERRAVANTI-WELLS —Obviously. Are these provided on the minister’s request or is it a report provided on a regular basis.

Ms Halton —It is regular.

Senator FIERRAVANTI-WELLS —Is that weekly, fortnightly?

Ms Halton —We will have to check that. It is fortnightly.

Senator FIERRAVANTI-WELLS —In the most recent report does it stipulate the election commitments that are partly or wholly incomplete and the reasons for that?

Ms Halton —No, and I do not have it with me. It would stipulate progress against timetables in relation to everything that we are working on.

Senator FIERRAVANTI-WELLS —That would, of course, by implication include whether you have partly or wholly completed what you promised that you would do. I would assume it would contain time lines, Ms Halton.

Ms Halton —It is a project planning arrangement.

Senator FIERRAVANTI-WELLS —I might move to one of those spectacular commitments that you made on GP clinics, Minister, and spend some time on those if I may. We now have 2½ which are fully running.

Ms Thompson —We have three fully up and running.

A document was then shown—

Senator FIERRAVANTI-WELLS —If you could assist me, Ms Thompson, I have gone to your website and on your website you have this coloured map. I have enlarged it so that we can see it, but I think it is pretty self-explanatory—

CHAIR —Is that from the website?

Senator FIERRAVANTI-WELLS —It is—and I have enlarged it. Ms Thompson, do you recognise the map?

Ms Thompson —Yes.

Senator FIERRAVANTI-WELLS —This comes from your website. In fact, I had this printed off yesterday evening. This says: ‘GP Super Clinic Locations (as that November 2009)’. So anybody looking at this on your website would think, ‘Isn’t that wonderful. We’ve got all these GPs superclinic locations.’ That is the inference from that document, is it not?

Ms Thompson —I am sorry, I cannot comment on that. I would not make that inference.

Senator FIERRAVANTI-WELLS —If I look at this map, it is not unreasonable to assume—

Senator Ludwig —Chair, it would depend on what else is on the website and what the underlying annotations are in relation to the website. I am just discerning whether there is actually a question in relation to that other than a statement which the witness is required to provide an opinion on. The witness is not in a position to provide an opinion on it. If there is a question that can be more usefully put then I am comfortable with that.

CHAIR —Senator Fierravanti-Wells, you are moving to a question?

Senator FIERRAVANTI-WELLS —I am, because other material on the website, Minister, says:

Welcome to the Australian Government’s GP Super Clinics Program.

And of course it tells us that you have

... committed $275.2 million over five years ... to establish GP Super Clinics in 36 localities across Australia.

It talks about the additional ones et cetera.

On this site you will find a wide range of up-to-date information about the Australian Government’s GP Super Clinics Program, including information specific to each—

Then it goes on about each of them. My point is: when you read that and you go into the website, the inference here is that these superclinics are up there running already, because it actually says ‘Super Clinic Locations’. It does not say ‘Proposed GP Super Clinic Locations’; it actually says ‘GP Super Clinic Locations’. It is certainly not being accurate because we only have 2½ actually up and running and that can actually said to be operational. Why are you leaving on the website something that is clearly trying to infer that these superclinics are all up and running when clearly they are not?

Ms Thompson —In fact there are three up and running, there are eight delivering early services and there are 17 that have commenced construction. I would also comment that you cannot necessarily read things on the website out of context. You need to read everything that is on the website, which gives a full outline of the program, including all the criteria for establishment. I can go through all of the locations and give you an update, if you would like.

Senator FIERRAVANTI-WELLS —I have looked at the questions that you have provided and I have also taken the liberty of having a look at the website. What I would like to do is take some of these, if I may, and just go into some of the detail that is available, because what seems to be mostly available on the website is really just the consultations that you have undertaken.

For example, if I look at ‘GP Super Clinics’ then ‘Victoria’, there are minutes there: ‘Summary of local information and consultation meeting’; I do not actually have information on when the proposed ones in Victoria—which are supposed to be in Ballan in Ballarat, Bendigo, Berwick, Geelong, Portland, South Morang, Wallan and Wodonga—will be up and running. Let us look at them.

Senator Ludwig —Looking at the website—

Senator FIERRAVANTI-WELLS —So you have gone there, too, Senator Ludwig!

Senator Ludwig —Certainly, because I can, but what it says is:

On this site you will find a wide range of up-to-date information about the Australian Government’s GP Super Clinics Program, including information specific to each of the 36 GP Super Clinics localities.

I have just taken a part of that. You can then go to ‘GP Super Clinic Locations’ and it then says:

GP Super Clinics have been announced in 36 localities—

so there is nothing misleading about that—

across Australia, as shown in the map below—

and obviously on the map they are highlighted. You can then go to particular localities and, if you go to localities, you can then see where they have got further and better information about the types of clinics in, for instance, Queensland. It then gives you detailed information about where you can update the information.

In ‘New South Wales’, if we can use that as an example, it says:

The Commonwealth has committed to establishing nine GP Super Clinics in New South Wales at the following locations—

and then it goes through the locations. So it does not say that they are established or up and running; it says ‘The Commonwealth has committed to establishing’. If you go through it, it then says:

Funding agreements have been executed with—

and goes through the various places; I will use that general statement. It then gives you phone numbers and contact details. Down the bottom it says:

The details of the Commonwealth’s funding, including the engagement approach, is outlined in the table below.

So you then see, ‘Blue Mountains’, ‘Up to $5.0 million’, ‘Commonwealth led Invitation to Apply process’, and ‘Date of Local Information & Consultation Session,’ so that if you are interested in that particular one you can go to the summary of outcomes. I am providing additional comment to the chair in relation to the question to assist people, but I do not support the argument in the question put by Senator Fierravanti-Wells that the site is misleading in any way.

CHAIR —Thank you, Minister; that was an extensive response. But I am just wondering if Senator Fierravanti-Wells—

Senator FIERRAVANTI-WELLS —This is going to be another case where Senator Ludwig’s interpretation is different from mine. It is just that when you read ‘GP Super Clinic Locations’, this document suggests, or one would assume, that those locations are actually up and running. I will not go through each of them, but I will go to some of them.

  • GP services (including access to a female GP);
  • After hours services;
  • Maternity services;
  • Mental health services;
  • Dental services;
  • Pharmacy services;
  • Practice nurse services; and
  • Youth support services.

Which of these services are being supplied at that clinic?

Ms Thompson —The Ballan GP superclinic was opened in September 2009. It offers chronic disease management services focusing on heart disease, diabetes and asthma. For the first time, there is a female GP in the town; there are practice nurses; there are dentists, for the first time, both private and public; and visiting specialists—for example, an occupational physician. There is also a range of allied health services: audiology, physiotherapy, podiatry, dietetics and nutrition, psychology, mental health services, occupational therapy and pathology. There have been over 29,000 presentations, including over 10,000 allied health presentations, to date.

Senator FIERRAVANTI-WELLS —Are there pharmacy services there?

Ms Thompson —There is an existing pharmacy very close by.

Senator BOYCE —What about dental services?

Ms Halton —There are also dental services—and it is not just dental services. I have actually visited this particular clinic, so I am quite familiar with it. When I visited, which was a couple of months ago, not only had they managed to attract a dentist—I think it was for four days a week; I could be corrected on that—but they had also managed to attract an orthodontist to come and practice in the town. I think it was for about one day a week.

Senator FIERRAVANTI-WELLS —Ms Halton, I am impressed that you got to go rather than the Prime Minister. This must have been one that just slipped his mind and he could not quite be there. He must not have been available on that day.

Ms Halton —I cannot comment on that, Senator, but I can tell you that I thought it was a particularly good centre. I was very pleased to have the opportunity to talk to staff when I went.

Senator FIERRAVANTI-WELLS —That is very good to hear because, given the number that you promised and given that this is the first one to open of the 36 that you have promised, it has taken a very long time. Anyway, it is good to see that at least the first ones are up and running. Are these services available full time or only at particular times?

Ms Thompson —That general practitioners are full time. I would have to check on the rest.

Senator FIERRAVANTI-WELLS —Right.

Ms Halton —Again, I can provide information here. As I said, there are a range of services and, certainly on the day that I went, the physiotherapist was there, the psychologist was there, the social work was in play, the GPs were practising and there were practice nurses. I met all of these people, and they were actually quite surprised that the dentist was working there four days a week. I do not think they expected that level of service. I think they were also genuinely pleased that the orthodontist chose to visit one day a week. So I think the expectation was not that every single one of these services would be full time; there is not enough business, if I can put it that way. But what it does—and what the advantage of these facilities is—is it provides a venue not only for people to practise there permanently if that is appropriate for them but also for them to accommodate visiting practitioners and indeed train students in a variety of health and related professions.

Senator FIERRAVANTI-WELLS —This one I am holding up refers to itself as the Ballan community centre. Are the GP superclinics supposed to be named superclinics, or they can just choose whatever name they want to go by?

Ms Thompson —We certainly like them to use the GP superclinic as part of their name.

Senator FIERRAVANTI-WELLS —But there is no obligation to do so?

Ms Taylor —The names of the clinics do vary, but essentially we ask them to identify that they are part of the GP superclinic network. So they do have various names.

Senator FIERRAVANTI-WELLS —Okay, but as part of their funding they are not required to be called ‘superclinic’?

Ms Taylor —They are required to identify that the Commonwealth has contributed to that clinic and identify themselves as part of the network.

Senator FIERRAVANTI-WELLS —Like a plaque on the wall or a sign on the front?

Ms Taylor —Yes.

Senator FIERRAVANTI-WELLS —What happens after hours? Do people go to the hospital?

Ms Taylor —I am just checking the after-hours arrangements at that superclinic. They operate from 8.30 am to 6.30 pm, Monday to Friday, and 9 am until 1 pm on Saturday. They have an after-hours roster with an on-call doctor who provides overnight coverage. That is part of an established roster arrangement with the hospital.

Senator FIERRAVANTI-WELLS —So they do not go to the hospital? Out of hours they are referred to another doctor. Is that how it works? One of the stated aims of these GP clinics is to take pressure off the local hospital. That is why I am asking what the arrangements are.

Ms Taylor —They participate in an after-hours roster to cover the after-hours period.

Senator FIERRAVANTI-WELLS —I will put some other questions in relation to each of the other clinics, but I have some questions about Portland. Senator Ryan, do you have some questions about Portland?

CHAIR —Senator Furner has a question about one of the clinics, if that can come in now.

Senator FIERRAVANTI-WELLS —I am going to do it state by state, Chair. I just thought that might be an ordered way of doing it.

CHAIR —Sure. You are in Victoria now?

Senator FIERRAVANTI-WELLS —I am doing Victoria now.

CHAIR —That is fine. We will get to Queensland—

Senator FIERRAVANTI-WELLS —That might make it easier, rather than going all over the place.

CHAIR —No worries. Senator Ryan on Victoria?

Senator RYAN —I have some questions around the contract with the Portland superclinic. To whom does Anne Thorpe, who I understand is listed as director of GP superclinics, report?

Ms Thompson —She reports to Meredeth Taylor.

Senator RYAN —Are you aware that on 19 May—the time, I have been informed, was 9.36 am—an email went from a person in that area to the CEO of the community health group that was signing the agreement with Portland, which indicated that the department would like the attached agreement signed by lunchtime?

Ms Thompson —I am aware of an email. I do not believe it said that.

CHAIR —Do you have a copy of the email?

Senator RYAN —I do. It has my notes on it. I am not sure if I particularly wish to table it, for that reason.

Ms Thompson —Sorry, Senator Ryan. Meredeth has just corrected me and she says it did say that.

Senator RYAN —It did. That makes it easier.

CHAIR —Do the officers have a copy of the email? If Senator Ryan is going to be referring to it, it might be useful—

Senator RYAN —That is the only fact I needed to establish. The email said that the department would like a contract signed by lunchtime today, that day being Wednesday 19 May. I am assuming that that was not the first time that the Portland group had seen a copy of the contract.

Ms Thompson —In fact, there had been numerous emails and telephone exchanges over several months in relation to the negotiations around the signing of the agreement which is, as you can understand, absolutely what we would do in all contract negotiations.

Senator RYAN —Was that the first time they had seen the final version of the contract? These contracts, I understand, would have iterations—hence the process you have outlined. Was that the first time they had seen the final contract, which I understand is now signed?

Ms Taylor —That was, indeed, the final, but there had been various iterations up to that point. There was very little in that contract, as I understand it, that was any different to iterations that they had seen for quite some time.

Senator RYAN —But that was the final contract.

Ms Taylor —As I understand it, yes.

Senator RYAN —And there had been changes since the previous version they had seen.

Ms Taylor —We sent them a previous version and my understanding is we had a conversation about one or two minor changes. We sent that contract back with those minor changes included in it.

Senator RYAN —When did that conversation take place?

Ms Taylor —Which conversation?

Senator RYAN —You said you had a conversation in this process. Immediately before this contract was sent you said you had a conversation with Portland group—I assume it was with the CEO but I am not going to put names to it—some minor changes were made and it went back to them for their final signature. When did that conversation take place?

Ms Taylor —I do not have that exact detail with me at the moment.

Senator RYAN —Could you take that on notice, please.

Ms Taylor —I can take that on notice.

Senator RYAN —Can you indicate whether it would have been days or weeks, when that final conversation took place?

Ms Taylor —As I said, there were several exchanges of contracts prior to that period—

Senator RYAN —I understand that. I am trying to chase down the time between the penultimate contract, your conversations and the verbal agreement on minor changes, and when they saw the final contract.

Ms Taylor —I will endeavour to provide you dates and times.

Senator RYAN —How many contracts have been signed for GP superclinics across Australia?

Ms Thompson —There are 36 signed.

Senator RYAN —That correlates with the 36 announced. That was mentioned earlier. Are they the same 36?

Ms Thompson —There is one extra, which is the Wallan superclinic, which has not signed, as yet. It is the same 36, but there is one that is unsigned. The signing of it, we hope, will be very soon.

Senator RYAN —The Portland one is obviously signed as well.

Ms Thompson —Yes.

Senator RYAN —Was the Portland one signed that day, before lunchtime?

Ms Taylor —I do not remember the exact time.

Ms Thompson —We will have to take that on notice. We do not have the exact time with us.

Senator RYAN —Was it signed that day?

Ms Thompson —It was signed on the 19th.

Senator RYAN —For the other contracts that you have signed, were there similar requests with respect to the timeliness of the signatures?

Ms Taylor —We work closely with the funding recipients right through those processes and that would not be an unusual request to us, for funding agreements to be signed within a particular time frame, given that we have been working with the organisations to those particular time frames. There are no surprises with this. We worked consistently and over a period of time with all of the funding recipients.

Senator RYAN —I am not disagreeing that this would be a very iterative process. How much is the Portland superclinic worth roughly?

Ms Taylor —I think it is $4.9 million.

Senator RYAN —Are you aware of whether the group, Portland District Health, had the opportunity to have a board meeting to discuss and agree to sign off on the contract prior to your request?

Ms Taylor —I am not aware of that. We deal with a particular person in the organisation, and their internal workings are a matter for their organisation.

Senator RYAN —I will come to that. This is over $4 million, and if I am generous and assume lunchtime is one o’clock, they have had less than 3½ hours to sign it. Is that typical of the time line allowed? If I sat here and asked you about every other contract, would that seem atypical or typical? Would they be given less than half a day to sign a contract?

Ms Taylor —Out of context, that seems a rather interesting question to ask. As I said, it is an iterative process in every case that we have had. I could not put my hand on my heart and say every funding organisation had had days and weeks and months to look at every single contract, but—

Senator RYAN —With all due respect, I think I have made my point—that is, that 3½ hours is not the same as days, weeks or months; it is less than half a day.

Ms Taylor —And I would make the point that they had seen various iterations that were very similar to that final funding agreement well prior to that time frame.

Ms Huxtable —Senator, there were a number of times that funding agreements went to and fro from us to that organisation over several months.

Senator RYAN —Who instructed this officer, who reports to Ms Anne Thorpe, to ask for this agreement to be signed by lunchtime?

Ms Thompson —I am not aware of the exact exchange of information between officers but, as Ms Taylor has said, this was an iterative process. This was the last stage of it, and that was the process that was in place.

Senator RYAN —I am getting to the point: someone made a decision to say this had to be signed by lunchtime. What I would like to know is who made that decision and who directed this officer, or was it this officer’s personal decision—and I doubt that. This is a pretty specific and strict request, so who made the decision to direct the officer to have it signed by lunchtime?

CHAIR —Senator, it is most unusual in these estimates to come down to individual personal responsibility. I am happy for the department officers to respond, but what tends to happen is that the branch in which it takes place takes responsibility. It is not our practice to say, ‘Claire Moore sent that email.’ It is not what we do in this process.

Senator RYAN —On certain occasions, Chair—

CHAIR —Not in this estimates committee.

Senator RYAN —Can I finish my sentence? I am getting to the point—I am happy if a branch takes responsibility. So it was a branch decision?

Ms Thompson —It is part of the division that I am responsible for and I take responsibility for all of the decisions within my division.

Senator RYAN —What I am trying to chase down here is this: given the time line, an interesting request—were you directed by anyone or was it a branch decision for which you are taking responsibility, to use the words that you have just used?

Ms Thompson —I was not directed by anyone in relation to the Portland funding agreement.

Senator FURNER —Senator Ryan, do you support the Portland superclinic at all?

Senator RYAN —I did not think this was a forum for questioning senators, Senator Furner.

Senator FURNER —No, it was just an observation. You seem critical of—

Senator BOYCE —Point of order, Chair. I thought we were asking questions of the department.

CHAIR —Senator Boyce, I accept your point of order. Senator Ryan is in the midst of his questions.

Senator RYAN —Subsequent to the signing of the contract, was there any discussion with people in your branch? I will come to the minister’s office soon and I understand, Senator Stephens, that you probably will have to take that on notice. So were there any discussions between members of the department and Mr O’Neill or Mr Govanstone about the media commentary that subsequently appeared about the signing of the superclinic contract?

CHAIR —For the information of the committee, I take it Mr O’Neill—

Senator RYAN —Sorry, Mr O’Neill is the CEO and Mr Govanstone is the chairman.

CHAIR —Sure. I just thought it was important that that be said.

Senator RYAN —My apologies.

CHAIR —That is fine.

Ms Thompson —I certainly have not spoken to Mr O’Neill. I understand Ms Taylor has and he rang to express his concern that he had been characterised in the media in the way that he had been. He expressed to us, and he subsequently stated in the media, that he had not been put under any pressure in relation to the signing of the agreement.

Senator RYAN —I am aware of his statement to the media. I am also aware of the original email that he sent. This is the point that I am going to. Were the discussions you had with Mr O’Neill initiated by him?

Ms Taylor —The initial discussions, yes. They were initiated by him.

Senator RYAN —And they were regarding the initial media commentary?

Ms Taylor —Yes.

Senator RYAN —And the way it was characterised seconds ago is the way you would characterise the conversation?

Ms Taylor —Yes.

Senator RYAN —Senator Stephens, can I ask you to take on notice whether there were any discussions between the minister’s office and the CEO or chairman—so Mr O’Neill or Mr Govanstone—regarding the media that appeared subsequent to the signing of the Portland GP superclinic agreement and what the nature of those conversations was.

Senator Stephens —Certainly.

Senator RYAN —That is all I have on this issue, Chair.

Senator FIERRAVANTI-WELLS —In relation to the material, it is not clear from the website about each of these superclinics. It talks about a lot of information but it does not actually give me when a superclinic will be operational. Can I go through the Victorian ones and ask if you can tell me when it is anticipated that each of them will be fully operational. Is Ballan East fully operational?

Ms Taylor —Yes.

Senator FIERRAVANTI-WELLS —And what about Bendigo?

Ms Taylor —At this stage we believe Bendigo will be completed around mid-2011.

Senator FIERRAVANTI-WELLS —Berwick?

Ms Taylor —Same time frame: mid-2011.

Senator FIERRAVANTI-WELLS —Geelong?

Ms Taylor —With Geelong we anticipate late this year, 2010.

Senator FIERRAVANTI-WELLS —After what Senator Ryan said, when you said you anticipated that it would be operational—

Ms Taylor —We believe—

Senator FIERRAVANTI-WELLS —When I say ‘operational’ I mean fully operational—

Senator BOYCE —So patients walking in the door and seeing people who actually work there.

Senator FIERRAVANTI-WELLS —That is right.

Ms Taylor —We believe Portland will be completed by late 2011.

Senator BOYCE —Does that mean operational, Ms Taylor?

Ms Taylor —As close to as possible. It might take them a day or a week to wrap up getting the services in there. We see it as one and the same date.

Senator FIERRAVANTI-WELLS —I am assuming that this is operational—as you said, operating with patients.

Senator BOYCE —I did check what the definition of ‘fully operational’ was at last estimates.

Senator FIERRAVANTI-WELLS —Did you?

Senator BOYCE —Yes, just to be sure that we were talking about the same thing when we say that.

Senator FIERRAVANTI-WELLS —So we are all talking about patients walking in the door. South Morang?

Ms Taylor —Late 2011.

Senator FIERRAVANTI-WELLS —Wallan?

Ms Taylor —At this point we believe Wallan will be operational also by that date. We have not signed the funding agreement yet with Wallan. But we have been working with them on the funding agreement and we have been working on a timetable for that clinic being operational by late 2011.

Senator FIERRAVANTI-WELLS —Wodonga?

Ms Taylor —Early 2012.

Senator FIERRAVANTI-WELLS —To be clear, ‘fully operational’ means patients walking in the door, everything done and everybody on staff, give or take one day.

Ms Taylor —That is our expectation.

Senator FIERRAVANTI-WELLS —I will leave Victoria if I may and move over to Queensland. We have got Strathpine.

Ms Taylor —Which is opened.

Senator FIERRAVANTI-WELLS —Yes, and the health priorities raised during consultations there included Aboriginal and Torres Strait Islander health services, outreach services such as mobile dental and care for the aged, and visiting specialists and services from GP clinics including oncology and radiology. Which of these services are currently being supplied at Strathpine?

Ms Thompson —The Strathpine clinic, as you know, opened in January this year. It offers services in general practice. It has allied health professionals and an Indigenous health nurse. The services include diabetes education, dietetics, physiotherapy, exercise physiology, x-ray, audiometry, psychology, podiatry and mental health. It operates seven days a week. It is open from Monday to Friday from 8 am until 7 pm and Saturdays and Sundays from 9 am until 5 pm. It will bulk-bill all MBS services. There have been over 17,000 presentations to date, including 3,950 allied health nurse and specialist presentations.

Senator FIERRAVANTI-WELLS —There is bulk-billing with a current Medicare card?

Ms Thompson —Yes.

Senator FIERRAVANTI-WELLS —Home visits?

Ms Thompson —No.

Senator BOYCE —Are you able to tell us how many services for Indigenous people have been offered?

Ms Taylor —No, I do not have that degree of detail.

Senator BOYCE —How will you know that it is meeting the needs of the Indigenous community in the area?

Ms Taylor —There is Indigenous representation on their community consultation group, which is an ongoing group that services the clinic, and we expect to get ongoing feedback from that Indigenous local community through those processes.

Senator BOYCE —Is this an individual or a representative organisation?

Ms Taylor —It is an individual that represents the local community.

Senator FURNER —Is the name of the organisation the Bunya—

Ms Taylor —That is right. It is representation from the local Indigenous community.

Senator BOYCE —Is there a dental service offered there?

Ms Taylor —I do not believe there is at this point. They are negotiating to bring that dental service on-stream.

Senator BOYCE —That would be mobile or someone actually working in the—

Ms Taylor —I do not believe it would necessarily be mobile; I believe it would be located within the clinic.

Senator FIERRAVANTI-WELLS —Are there visits to nursing homes?

Ms Taylor —I am not aware that they specifically do visits to the aged-care facilities in the local area.

Senator FIERRAVANTI-WELLS —That was one of the priorities identified. You are not aware whether that is happening?

Ms Taylor —No, I am not aware whether that is happening.

Senator FIERRAVANTI-WELLS —Perhaps you could take that on notice. Is Strathpine considered a district of workforce shortage?

Ms Taylor —Not currently.

Senator FIERRAVANTI-WELLS —Have any of the medical authorities required any of the doctors at this clinic to be supervised by another doctor or placed conditions on their registration?

Ms Taylor —I am not aware that that is the case.

Senator FIERRAVANTI-WELLS —Could you take that on notice and, if so, who provides that supervision or what the conditions of their registration are; on what dates and times is that supervision provided; and are any of the doctors working at that clinic subject to a 10-year Medicare moratorium? Further, what exemptions have been granted, if any? Are any of the doctors at this clinic practising there for a special purpose activity?

Ms Taylor —I am not aware of that; again, we will check that.

Senator FIERRAVANTI-WELLS —Are there any overseas trained doctors employed at the clinic who have been registered as medical practitioners in Australia for less than 10 years? Do any of them have any exemptions under the Health Insurance Act? Have other GP practices within the Strathpine area sought Medicare provider numbers for overseas trained doctors who do not meet the 19AB exemptions? Can you also tell me, if there were any such requests, how many, when and what the results have been?

Ms Thompson —We will have to take that on notice.

—Can you tell me if there has been any special treatment given to this superclinic—anything outside the ordinary?

Ms Taylor —Not that I am aware of. Not from our perspective, no. I am not sure what you mean by any ‘special treatment’. We will check the exemptions.

Senator FIERRAVANTI-WELLS —That would be helpful.

CHAIR —I am sorry to interrupt, Senator Fierravanti-Wells, but Senator Furner has a question about the Strathpine clinic in Queensland.

Senator FIERRAVANTI-WELLS —By all means. Jump in. I have finished with Strathpine. I was going to move on to Logan. So by all means go ahead, Senator Furner.

Senator FURNER —Thank you. Senator Fierravanti-Wells has covered most of the questions I was going to ask. Nevertheless I still have a couple of questions.

Senator FIERRAVANTI-WELLS —You can agree with me, Senator Furner. Senator Cameron does every so often.

Senator FURNER —I agree wholeheartedly with the success of the superclinics, particularly the one at Strathpine. It has been an amazing achievement. Ms Taylor, firstly, it was opened on 29 January, well ahead of schedule. Was there any particular reason why that was the case?

Senator BOYCE —Which schedule was that, Senator Furrner?

Senator FURNER —Ignore the interjections, Ms Taylor.

Ms Taylor —A large part of the reason was that it was an existing building, so it was a clinic that needed minimal refurbishment to have it up and running, in terms of the physical premises. It was a fairly straightforward transaction. As I understand it there were also fairly straightforward council requirements that were met. I could not say that for all the sites.

Senator FURNER —Is that consistent with some of the proposed superclinics—for example, those sites displayed on the map on your website?

Ms Taylor —There is a great variation. Some of them require land to be purchased right back at the beginning of the process; others will simply be a refurbishment of an existing building. Although I say ‘simply’, sometimes it is on a major scale as well and takes significant time. But there is a variety across the spectrum of the land and building arrangements that will be in place for the clinics.

Ms Thompson —Senator, if I could just add: this is a capital infrastructure program and that is why it is a five-year program. It does have to take into account the process of building or refurbishing, including planning permits, architectural design, building workforce—and, at the end of all that, the actual GP and allied health workforce. So there are many steps in this process to ensure we get the superclinic up to meet the needs as identified in the area.

Senator FURNER —Of course, that varies from location to location, depending on the state of the building that requires refurbishment or expansion.

Ms Thompson —Yes, that is right. In addition to that, the consultation process around superclinics was very important to ensure that we understood the service provision in the first place. All of those consultations took time, but they were very important in determining that need.

Senator FURNER —With respect to the Indigenous elders, I am quite familiar with the Bunyabilla group and I know they are extremely impressed with the interaction—the clinic and the ease of transportation—

Senator BOYCE —Are you able to table those documents in regard to that, Senator Furner?

Senator FURNER —access to the shopping vicinities. I am wondering what feedback you have received from, for example, Bunyabilla.

Ms Taylor —We have not spoken directly to that service but we are aware, as I said, that that service is represented in the clinic’s community consultation process. So we will seek some of that feedback and I am sure we will have buckets of feedback on this particular issue, because Indigenous health services were not something easily accessed prior to the advent of the Strathpine superclinic.

Senator FURNER —There is a medical library upstairs as well, as I understand.

Ms Taylor —There is. That is right. That is accessible.

Senator FURNER —Is there any feedback on how that is being used by the community—whether practitioners in the area or students are taking up that opportunity?

Ms Taylor —Again, we do not have specific information on that, but it is something we can chase up.

Senator FURNER —I have some questions that deal with GP superclinics in general, which I can leave for later.

CHAIR —Do you want to finish Queensland first, Senator Fierravanti-Wells? Go north to Logan, and then we will get the general questions.

Senator FIERRAVANTI-WELLS —I also have some general questions at the end, so I wonder whether—

CHAIR —I am in your hands. It is your time.

Senator FIERRAVANTI-WELLS —Okay. I would like to go to Logan, if I can. First of all, can I go through the list of the GP superclinics in Queensland and ask when they will be fully operational. We will start with Brisbane Southside—the Logan one.

Ms Taylor —There are two parts to Brisbane Southside—there are both the Annerley site and the Logan site. The Annerley site should be operational around September this year. The Logan site will be somewhat later—late 2011.

Senator FIERRAVANTI-WELLS —Bundaberg?

Ms Taylor —For Bundaberg, we are looking at a time frame of early 2012.

Senator FIERRAVANTI-WELLS —Cairns?

Ms Taylor —Cairns, again, is one of those sites that have a number of parts to them. Cairns should be operational by mid to late 2011. There is a component of the Cairns superclinic that is currently operational, providing GP, nursing and mental health services at their Woree spoke.

Senator FIERRAVANTI-WELLS —Yes, but it is not fully operational in the sense that—

Ms Taylor —It is fully operational at that spoke, but no; it is part of the bigger superclinic, yes.

Senator FIERRAVANTI-WELLS —Can I just understand this. I know that Senator Boyce traversed this on the last occasion, but can you delineate what you mean by ‘fully operational’. I know that we have gone through this but, for the record, what does ‘fully operational’ mean to you?

Ms Taylor —I did say that the Cairns superclinic will be fully operational by mid to late 2011, so we are not claiming that it is fully operational now. That is certainly not the intent of my previous comment. The time frame for Cairns to be fully operational—all the parts of that particular model to be up and operating—is mid to late 2011.

Senator FIERRAVANTI-WELLS —What about Gladstone?

Ms Taylor —For Gladstone we are running on a time frame of mid to late 2011.

Senator FIERRAVANTI-WELLS —Ipswich?

Ms Taylor —Ipswich will be fully operational by early 2012.

Senator FIERRAVANTI-WELLS —What about Mount Isa?

Ms Thompson —I can speak to that. With Mount Isa we are not sure. We have some issues with their capacity to get up and running, and we are considering some options around that one at the moment.

Senator FIERRAVANTI-WELLS —So you do not know about that one.

Ms Thompson —No.

Senator FIERRAVANTI-WELLS —Redcliffe?

Ms Taylor —Redcliffe is mid-2011.

Senator FIERRAVANTI-WELLS —We know about Strathpine. Townsville?

Ms Taylor —Townsville is late 2011.

Senator FIERRAVANTI-WELLS —I want to go now, if I can, to the Logan one. The GP Super Clinics National Program Guide states:

GP Super Clinics must complement and enhance existing health services—

and they should—

… be a supported addition to the local community.

Does the Brisbane Southside clinic at Logan meet those criteria?

Ms Taylor —As far as I am aware, yes.

Senator FIERRAVANTI-WELLS —So can a tenderer—in this case, the University of Queensland—change its plans or models from its tender application after winning the tender?

Ms Taylor —It can moderate its plans, depending on whether the original site is still available. Sometimes sites are sold out from underneath our funding recipients. Sometimes the tenancy arrangements might change. So we need to be a little flexible around what we consider to be a major change as opposed to a minor change in clinic locations.

Senator FIERRAVANTI-WELLS —All right. So what guarantee does the government have that it gets what it tenders for?

Ms Taylor —I am not sure what you mean in that regard.

Senator FIERRAVANTI-WELLS —In this case, the site of the Logan clinic, there is an issue because the original proposal was to put it on one side—are you aware of this or familiar with this?

Ms Taylor —I understand that there is now a proposal to potentially put it across the road from the original site.

Senator FIERRAVANTI-WELLS —Yes, that is my point. One would think that that is a major change. In other words—

Ms Taylor —I do not necessarily agree with that assessment, that moving it from one side of the road to the other is a major change.

Senator FIERRAVANTI-WELLS —Oh. Well, it does, depending on whether the facilities that are available on one side are the same as those you originally tendered for on the other side. That was why I asked the question. Anyway, you had a site originally set out in the tender process. Was the site that was outlined in the tender process the Meadowbrook village shopping centre?

Ms Taylor —As I understand it, it did include the Meadowbrook Medical Centre, not necessarily the Meadowbrook shopping centre.

Senator FIERRAVANTI-WELLS —Okay. And the new site that the University of Queensland has successfully tendered for is across the road?

Ms Taylor —I understand that those arrangements are in process.

Senator FIERRAVANTI-WELLS —Right. The Meadowbrook village shopping centre already contained a general practice, Medihealth pharmacy and pathology practice, so it fitted the bill for your complementing and enhancing existing health services and being supportive of the local community.

Ms Taylor —Yes, but I do not understand why a clinic located on the other side of the road cannot equally provide those services.

Senator FIERRAVANTI-WELLS —No, I am trying to get to another issue. You accept one tender and then there is a substantial variation of that tender, and I am asking you what your position is in relation to acceptance of that major variation. In this case, you have moved from one concept, where you have got an established set of services on one side, to the University of Queensland winning the tender and shifting operations to the other side of the road. That is the point that I am trying to make.

Ms Thompson —Senator, perhaps I could comment on that. I think, with any capital program, this sort of thing can happen and does happen. What we do when these things happen is ensure that the criteria that applied in the first place are still met, and those criteria are around the delivery of services to the community as assessed through the consultation process. We will always ensure that that fundamental objective of the program is met.

Senator FIERRAVANTI-WELLS —As I understand it, you had a group of doctors wanting to set up—they had the original idea. The doctors went to the University of Queensland. The University of Queensland, as I understand it, relied on their experience; they described it as an ‘established capability in establishing, developing and operating multidisciplinary medical centres’. After the University of Queensland won the tender, they basically dropped the doctors and the pharmacy, the original set-up. That is it, in a nutshell. So I am asking you: is that a part that you as the Commonwealth, from your perspective, are not interested in?

Ms Thompson —As I said, we will ensure that the criteria that need to be met are met and that the objective of the program is achieved—and that is the objective of the program.

Senator FIERRAVANTI-WELLS —The University of Queensland say, ‘Our site is part of an established shopping complex which already contains a medical practice, pharmacy and pathology service,’ and indicate that in the adjacent shops they could provide tenancy operations for other health services, and you award a tender on that basis. When that materially changes, I do not understand why you do not revisit that. Do you see the point that I am trying to make?

Ms Thompson —As I said, Senator, we do revisit and we ensure that the criteria that need to be met are met and that the objective of the program is met. That is what you do whenever circumstances change in terms of a contract arrangement. That is what you do.

Senator FIERRAVANTI-WELLS —All right. Now we have a situation where you have got a GP superclinic on one side of the road the tender process for which was built on, if I can use those words, the parameters of the experience and established capability of the doctors that are now operating across the road.

Ms Thompson —I am sorry, I did not hear your question.

Senator FIERRAVANTI-WELLS —At the moment you have got a situation where you have got doctors who are operating in the Meadowbrook Village shopping centre. You have got a practice that is operating there. That was the basis upon which the university originally built its tender. All of a sudden now the university has decided they are going to set up operations across the road, forget the doctors that they originally partnered with and now set up in competition across the road. So the GP superclinic is being funded across the road. My question is, surely there is some concern on the part of the Commonwealth in relation to those doctors whose goodwill, if I can put it in those broad terms, was utilised to form the basis of the original tender?

CHAIR —We have actually gone through this and I think the point is on the table, the issue you are raising. I would think that the officers could take that on notice, look at the consideration and give a briefing to Senator Fierravanti-Wells about this particular issue. I just do not sense we are moving forward on it.

Senator FIERRAVANTI-WELLS —I will stop it there, but you take my point. Is it going to be a process where if you cannot get a superclinic up for some reason, suddenly midstream you change your contractual arrangements? If we have seen it here, are we going to see it in other GP superclinic proposed locations?

CHAIR —When we get the briefing we will be able to see and you will be able to go from that point.

Senator Stephens —Chair, can I make the point that in relation to Senator Fierravanti-Wells’s questions on this issue I think there are some assumptions that are underpinning those questions that perhaps may not be exactly as she perceives them to be.

CHAIR —Perhaps that sometimes happens, Minister, but Senator Fierravanti-Wells has put her issues on the table, the concerns she has. Now we will see what comes back in terms of information.

Senator FIERRAVANTI-WELLS —I may provide, subject to what I can, separately documents to the department.

Ms Halton —That would be very helpful.

Senator FIERRAVANTI-WELLS —Now that you have got this here at Logan, they have advertised—

CHAIR —We are still in Logan, are we?

Senator FIERRAVANTI-WELLS —We are. There is another aspect to this that I would like to traverse. I find in the Australian Financial Review on 23-26 April an advertisement for the chief executive officer of the University of Queensland GP superclinics, which I read with some interest. We actually managed to get a recruitment package for this position, which runs to nigh on 20 pages. In this package is an absolutely fascinating little diagram. I will hold it up—

Senator Stephens —The officers cannot see that.

CHAIR —Would you like to pass that to the officers?

Senator FIERRAVANTI-WELLS —Let me just tell you it says: superclinic steering committee. This was a real noodle. I will provide you with a copy of this because I really want to understand, if this is the way every superclinic is going to be run, no wonder this is bureaucracy gone absolutely mad. Over here on this diagram you have got local reference groups. I do not know what those local reference groups are. You have got Ipswich, Annerley and Logan, and then you have got some letters under here which I am not sure what they mean. Then you have got a board of the superclinic, which I assume is part of the requirements. Is that the case for superclinics? Could somebody enlighten me as to whether they are required to have that?

Ms Thompson —They certainly have to have appropriate governance arrangements.

Senator FIERRAVANTI-WELLS —So you have ‘Board of UQ GP Superclinic Pty Ltd, 1 and 2’, obviously. Underneath that you have a CEO and a practice management company, then you have clinical model working groups, and then on this side of the equation you have a superclinic advisory committee and UQ faculty representatives. I will give you a copy of this. But if this is what is required for the CEO to run this superclinic it really is bureaucracy gone absolutely mad.

Senator Stephens —Senator, can I just say in response that, given the corporate governance requirements of companies in Australia, that is actually quite straightforward.

Senator FIERRAVANTI-WELLS —Are you saying that every GP superclinic will have that sort of structure? Is that what you are saying?

Senator Stephens —No, I am not saying that at all. I am saying that you see there that you have some companies limited by guarantee and therefore they have some requirements around that. The fact that it is associated with the university means that there are some requirements around that. I imagine that each GP superclinic has its own structure that recognises who the affiliated partners are.

Senator FIERRAVANTI-WELLS —Further in this document it has ‘Proposed organisational GP superclinic structures’: board of directors, CEO, business development manager—again, I will provide a copy of this. My question to you is: what is this structure typical of? Is it typical of just this GP superclinic or is it typical of what you are going to require for all GP superclinics? That is really my question.

Ms Thompson —I haven’t ever seen that document, so I cannot comment on it except to say that appropriate governance arrangements based around the GP superclinic at an individual level are things that we are interested in and pay attention to to ensure that the objective of the program is achieved. But it is quite right to say that each of these superclinics will have a governance structure that is applicable to their particular company structure or program activity, depending on where they are from.

Senator FIERRAVANTI-WELLS —This document contains not just the structure. This is 20 pages of ‘this is what you have to do’ et cetera. I will give you a copy of this but I really would appreciate it if you could tell me if this is what every GP superclinic is going to be doing and requiring—that is, if this is the norm or if the University of Queensland is just going outside it.

Ms Thompson —We could certainly provide the types of governance arrangements around the superclinics that are being developed or are currently operating, if that would be useful.

CHAIR —So you are going to exchange documents then? Senator Fierravanti-Wells, you will provide the information you have—

Senator FIERRAVANTI-WELLS —I will.

CHAIR —and then on notice, Ms Thompson, you will take that as part of the information you will get back to us. Thank you.

Senator FIERRAVANTI-WELLS —I have two short questions. Have the doctors involved in the Mount Isa clinic claimed that the clinic in that city cannot be built for the money allocated under this scheme?

Ms Thompson —We certainly have had advice that they do not believe they can proceed at this stage and we are working on options around that.

Senator FIERRAVANTI-WELLS —This is the one that you mentioned to me earlier—

Ms Thompson —Yes.

Senator FIERRAVANTI-WELLS —in that you are not sure what the options are and you are looking at other options?

Ms Thompson —We are considering options.

Senator FIERRAVANTI-WELLS —Could you take on notice to give me some information in relation to those options. Then there is the Bundaberg clinic. You told me it is going to be fully operational in early 2012. So what is the status of the clinic at Bundaberg?

Ms Thompson —I am sorry, Senator?

Senator FIERRAVANTI-WELLS —Earlier, when I ask the question about clinics being fully operational, I was told that Bundaberg would be fully operational in early 2012. My question is: what is the status of that clinic now?

Ms Taylor —For the Bundaberg superclinic, the funding agreement was signed in April this year. Land settlement is currently under way.

Senator FIERRAVANTI-WELLS —All right. I have finished Queensland, Madam Chair, and I was going to move on to New South Wales.

CHAIR —It may be useful then for Senator Furner to have his general questions—

Senator FURNER —I admit I am very patient, Chair.

CHAIR —I am just concerned that we have only another 25 minutes in this area before we get on to the agency. Is there anyone else who has any other issues in primary care that they would like to cover?

Senator FIERRAVANTI-WELLS —I will ask if you could, in relation to each—I am just conscious of time; if I can I will come back—give me, like you have for the other GP superclinics, details of when they will become fully operational in New South Wales and the other ones that I did not cover.

Ms Taylor —Yes.

Senator FIERRAVANTI-WELLS —Can you tell me about the Port Stephens facility in New South Wales? Again, with the services that were indicated would be available—diabetes services and increased access to X-ray services—are these available and are they full-time or part-time?

Ms Thompson —Yes. Port Stephens superclinic opened on 3 May this year. It operates Mondays, Wednesdays and Fridays between 8 am and 4 pm; Tuesdays and Thursdays between 12 noon and 8 pm; and Sundays from 10 am to 4 pm. It also provides a specific service to residential aged-care facilities on Tuesday and Thursday mornings. There are four GPs—two female—two practice nurses, a practice manager, and a range of allied health professionals including a psychologist, or psychologist services, diabetes educator, dietician, physiotherapist, podiatrist, pharmacists—in particular for medication reviews, and a visiting medical specialist—a geriatrician.

Senator FIERRAVANTI-WELLS —And do they bulk bill?

Ms Taylor —They do bulk bill a range of services, yes.

Senator FIERRAVANTI-WELLS —I would like to ask some questions about Warnervale.

CHAIR —Which state are we in?

Senator FIERRAVANTI-WELLS —New South Wales.

CHAIR —Okay. I had just lost where we were.

Senator FIERRAVANTI-WELLS —It opened in October 2009 but according to Minister Roxon’s press release it is only a temporary clinic until there is a permanent site in 2011. Is that the case?

Ms Taylor —That is correct. Early 2012—

Senator FIERRAVANTI-WELLS —Sorry?

Ms Taylor —Early 2012 is the expected completion date.

Senator FIERRAVANTI-WELLS —So the minister said early 2012. It has one full-time GP—is that the case? What is the GP situation there?

Ms Taylor —Yes, I understand they have at least one GP there.

Senator FIERRAVANTI-WELLS —Does it have bulk billing?

Ms Taylor —It does provide bulk-billed services, as far as I understand.

Senator FIERRAVANTI-WELLS —What about nursing home visits?

Ms Taylor —I do not believe they do nursing home visits specifically.

Senator FIERRAVANTI-WELLS —Okay. I found a position advertised for a general practitioner for that practice, and I am happy to provide you with a copy of it. It says, ‘There is no requirement for the GP to perform visits to aged-care facilities or nursing home visits.’ My question is: is this the situation with GP superclinics? I thought that was going to be one of the features of it. The government has made much in its announcement recently about encouraging GP visits to nursing homes. Indeed, Ms Podesta herself mentioned earlier, I think, 105,000 extra visits to nursing homes. It is interesting to see that at one of your GP superclinics it is almost there as an attraction for that prospective general practitioner that there is no requirement for GPs to perform visits to aged-care facilities or do nursing homes visits. I find it somewhat troubling that on the one hand the government is supposedly pumping money in to get GPs to visit nursing homes and here we have a GP superclinic that is basically saying they are not required to go and visit nursing homes.

Ms Halton —I cannot comment about the specifics, other than to say that we are very clear about our requirement in relation to a greater level of attendance at nursing homes. I do not know the details of the ad and I think it would be inappropriate for me to comment.

Senator FIERRAVANTI-WELLS —I will provide it. The point I am trying to make is about whether this is a feature of GP superclinics. I would appreciate it if you would look at this advertisement. We have just heard Ms Podesta’s evidence. There is a big fanfare about getting GPs to nursing homes. We know GPs do not want to go to nursing homes. It is almost as if it is being touted as a positive to the job that they do not have to go to nursing homes. I will leave it at that. I will provide the document to you, if you could take that one on board.

Ms Halton —Yes, but I might just make a comment. I cannot leave that sitting there, Senator. The bottom line is that saying GPs do not want to visit nursing homes is a comment that a number of people in the medical profession would regard as something that could not be let go without comment. We know of many practitioners who devote a significant proportion of their practice time to that. We think we need more of that, and that is what these arrangements are on about. I will look at this advertisement. I do not know, for example, how this particular service is structured. We know that in some services they may have a GP who focuses on adolescent health, for example. There are areas that people specialise in within general practice. So I think we need to have a bit more information before we leap to conclusions.

I would be quite clear that our expectation is that, particularly working with Medicare locals, GP superclinics would be part of providing a holistic service to people in that community, and that includes Australians who are resident in residential care.

Senator FIERRAVANTI-WELLS —Okay. Just one question in relation to Nelson Bay Plaza GP superclinic. I have been given various opening hours. They are very disparate: Wednesday, Friday, 8 am to 4 pm; Monday, Tuesday, Thursday, 8 am to 8 pm; Saturday, not open. And for Tuesdays and Thursdays, interestingly, it has: ‘1 pm to 4 pm: locals only, one problem. Walk in for minor ailments—example, sore throats’. Does that mean that at some GP superclinics we are going to start delineating when people can come in? It seems strange that you can only have locals with one problem. Is that a new feature or just particular to Nelson Bay? Have you come across it?

Ms Thompson —I am sorry Senator, I missed the beginning of the question. Where was that information from?

Senator FIERRAVANTI-WELLS —What I am saying is that an inquiry was made at this Nelson Bay Plaza superclinic and the advice is that on Tuesdays to Thursdays, 1 to 4 pm, it is: ‘Locals only, one problem. Walk in for minor ailments’. Is that a common feature of what we are going to start seeing at superclinics, that you will only be treated if you are a local with one problem?

Ms Thompson —I would have to check what is going on there.

—Fine. I will not go through the other states. I want to ask some questions in relation to the budget allocation of $355 million—3.5, 5.2—for an additional 23 GP superclinics and for 425 grants to GP practices. To describe it in a shorthand form, we have seen superclinics mark 1, which is the 36 or 37; then we have another 23, which is mark 2; then there is this new phase, which is these 425 grants to GP practices. I note that that is at page 214 of the yellow book. Could you tell me a bit about these? I cannot help but think that we have got 2½ fully operational and we are still in the first phase of superclinics and now we are talking about 425. We cannot even get through mark 1, let alone now the grand plan for mark 3.

Ms Thompson —The 425 relates to the number of grants, and I can detail those for you. The objective of that program is to upgrade and extend general practice, primary care or community health services, and Aboriginal medical services, to improve their facilities to allow them to expand the services to their communities. That is the objective of the program. We believe that that will give greater flexibility in service provision and allow and attract allied health professionals to GP practices.

Senator FIERRAVANTI-WELLS —At page 214 of the budget papers, as you go through it goes into the establishment of Medicare Locals—and we will come to that. You explain in the budget papers what Medicare Locals are going to do. It is very clear that you have introduced this new coordinated diabetes care program where, basically, you are going to allocate certain amount of money, if I understand, to a person who has got diabetes, and the figure I have heard is $1,200, but I am not sure if that is the case. Is that your understanding?

Ms Thompson —That is right. I can verify that.

Senator FIERRAVANTI-WELLS —That also means that that $1,200 not just includes that person’s diabetes care, but is everything else as well. Is that the case?

Ms Thompson —The new initiative relates to those people who choose to sign up to a practice that has agreed to deliver a coordinated approach to the care of people’s diabetes. There will be up to $1,200. Some of that will go to the practice and some will be a flexible pool that eventually will be held by Medicare Locals to deliver allied health services as required. The idea behind this is to create a greater engagement between the person, the patient, and the general practice and all the allied health services that they may need to deliver their care.

Senator FIERRAVANTI-WELLS —But does it also not take away choice of GP, because if you want diabetes care you have got to go to that doctor—you are allocated that doctor?

Ms Thompson —It is a voluntary enrolment.

Ms Huxtable —The patient voluntarily enrols with the general practice for the purpose of getting their care from the general practice. And, adding to Ms Thompson’s comments, there is also funding under this initiative that goes to general practice in respect of how their diabetes population are faring, and their performance payments that relate to that we expect on average to be just over $10,000 per practice. So there are a number of components of funding. There is the $1,200 per patient, which was referenced earlier, some of which goes to the general practice. There are also reward based payments that go to the practice as well.

Senator FIERRAVANTI-WELLS —So you are going to set up these Medicare Locals. How will they be formed?

Ms Huxtable —The Medicare Locals will evolve from divisions of general practice. However they will be much broader than divisions of general practice currently are. They will embrace a wider set of health professions within a local area and will have responsibilities to report on the health of our local communities. There is a range of elements that are in the ‘red book’ that I am sure you are all familiar with. The concept of Medicare Locals is grounded very much in both the considerations of the National Health and Hospital Reform Commission, but also in the primary care strategy which was also announced in final form on 11 May, and is really about having a much better regional focus on primary care provision complementing local hospital networks.

Senator FIERRAVANTI-WELLS —They will not actually be involved in patient care though, will they? They will just coordinate patient care; they will not actually see the patients themselves?

Ms Huxtable —There is a variety of measures in the budget papers, where there are moneys earmarked for Medicare Locals. Some of that relates to after-hours provision. There is the allied health funding which Ms Thompson has already referred to. There is also funding as part of that aged care measure. They will have a role in coordinating the provision of services. I think we need to be reasonably flexible as to the types of things that Medicare Locals will do because the whole point of this is to have primary health care organisations that are responsive to local communities. So we do not want to be too prescriptive around what their various functions are.

I think it is true to say that, on the whole, their role is to really understand what the needs of their local communities are, where there are gaps and where there are people who are vulnerable and disadvantaged who are falling through those gaps, and act to fill gaps in service delivery.

Senator FIERRAVANTI-WELLS —They will interact with the GPs. How will they know about patients and their needs? They are not actually treating patients themselves. Are they just going to be directing patients around their local area?

Ms Huxtable —They will be expected and be funded to have considerable information about what is going on in their local area in terms of the demographics of the population and the health outcomes that population is experiencing, and they will be identifying where there may be gaps or variations from what would be expected to be normal practice—I think there are many examples we could give in that regard—and they will be working closely with the local community and with the network of providers to put in place arrangements to fill those gaps.

Senator FIERRAVANTI-WELLS —There is really not a lot of detail about this yet. Where is the nitty-gritty about where they are going to be and the areas they are going to cover? We do not have any of that detail yet. It is just conceptually up there, despite what is in the red book.

Ms Huxtable —I was about to cite the red book. There is a significant amont of information not only in the red book but in the National Health and Hospitals Network Agreement.

Senator FIERRAVANTI-WELLS —I know, but we have not delineated the parameters of where they are, the area they are going to cover.

Ms Huxtable —That is right.

Senator FIERRAVANTI-WELLS —Is that going to be done in conjunction with the local health networks by the end of the year?

Ms Huxtable —That is correct. I think one of the important things here is the need to be very aware of what the circumstances of local communities are, what the catchment areas are and what the hospitals look like in those areas, and to work with stakeholders around defining these boundaries. I do not think they are the sorts of things that really can or should be imposed from a central place.

Senator FIERRAVANTI-WELLS —At page 225 you talk about the improvement of primary care. We were talking earlier about diabetes and the $1,200 that flows from that if patients go to a certain practice. I notice at page 225 that you are now talking about coronary disease, chronic obstructive pulmonary disease and improved access to others. Does that mean that we are looking at diabetes today but we are also looking at a series of other diseases further down the track that are going to be under the same formula, if I can put it that way?

Ms Huxtable —The reference on page 225 is to a quite specific program—the Australian Primary Care Collaboratives program. I am probably not the best person to question about the detail of that program.

Senator FIERRAVANTI-WELLS —Ms Halton, you obviously have experience with the British National Health Service.

Ms Huxtable —In fact, I was born under it.

Senator FIERRAVANTI-WELLS —I know. That makes me think that what we are starting to see sounds remarkably like a shift in that direction—towards a British national health service. We are bringing in these local networks, and this and that, which are not really local. It is almost as if people are going to be directed; that it is going to be: ‘You will go to this doctor and go to that doctor.’ Is this what we are starting to see?

Ms Halton —No.

Senator FIERRAVANTI-WELLS —A categoric assurance that we are not moving down that route?

Ms Halton —Absolutely.

Senator FIERRAVANTI-WELLS —I will put further questions on notice.

Senator SIEWERT —I am interested in how Medicare Locals are going to interact and evolve from the divisions of general practice. There are going to be fewer Medicare Locals than divisions of general practice. That is correct, is it not?

Ms Huxtable —I think that has been the expectation, but until those boundaries have been finalised I could not say that definitively.

Senator SIEWERT —In terms of how you are currently interacting with the divisions of general practice about how they will evolve into the new being, how is that proceeding? I am particularly keen on understanding then how it is going to happen in WA, where this is going to be funded, as I understand it from our discussion this morning, but the other issues around health reform are not going to be. There may be a different relationship between Medicare Locals and any of the local health networks.

Ms Huxtable —There are a number of questions there.

Senator SIEWERT —I know, sorry.

Ms Huxtable —I might try and take them in turn, if I can. In terms of Medicare Locals and divisions of general practice, really the foundation thinking around the primary healthcare organisation structures goes back to the Primary Health Care Strategy, which was developed with input from an external reference group. There has certainly been wide discussion in the sector about the value of primary healthcare organisations as a means to better coordinate, fill gaps and really address that issue about the MBS being good at the sort of transactional based service but not so good at managing long-term chronic disease.

For the Divisions of General Practice Network, there are absolutely no surprises in this. In fact, I know they have been doing quite a lot of thinking themselves about what it means for them, and we will obviously continue talking to them around this, but not only them. There are clearly a range of other primary healthcare providers who have an active interest in Medicare Locals. What is also in play here is the Commonwealth taking 100 per cent funding and policy responsibility for state based primary care services and, again, bringing those primary care services into the rubric of the Medicare Locals sort of planning environment, if you like. I am not sure if that has completely answered your question in regard to the divisions, but there is definitely an active dialogue with the divisions and with other primary healthcare providers now that we are moving to the next six months, which will really be bedding down the arrangements for Medicare Locals at their boundaries and also the process to select the first tranche of Medicare Locals, which is due to come on board in July next year.

Senator SIEWERT —I want to pursue that a little bit more in a minute. I know I asked a multipronged question. What about the issues around WA?

Ms Huxtable —Firstly I would say, as I did this morning, that discussions with WA are continuing, so I do not think that we can speak too definitively about where that might end. I think it is quite hypothetical to talk about a circumstance where there might be different arrangements in WA to the rest of the country, because those discussions are continuing, as I understand it. However—we may be going back a little bit on what was said this morning—the place of Medicare Locals in WA, I think, is a matter that really needs to continue to be discussed between governments.

Senator SIEWERT —Does that mean that there is a potential case where in WA we are not involved in the first tranche?

Ms Huxtable —That is hard to say, and I think it is a two-way discussion. I have not personally had discussions with WA about Medicare Locals and about what it might mean in WA, so I cannot say to you that they have firm views about those organisations, where they might be and how they might align with local hospital networks and the like. It is probably just a little early to say how that whole thing might proceed. Meanwhile, there are these parallel discussions occurring.

Senator SIEWERT —Okay. In your discussions with Senator Fierravanti-Wells, you were talking about the identification of gaps that are not picked up through the MBS process, and you just mentioned that again. My take on where we are at with some of the divisions of general practice is that there is a great deal of variety across Australia. Some seem to me to be more engaged in certain issues—for example, mental health. My observation is that that is not necessarily just based on there being a greater need in certain areas for mental health; it also depends on the level of engagement of some of the people involved. It seems to be a bit hit and miss. I am only picking on mental health as a particular example. How are you going to monitor and ensure that all the gaps are being met so you do not get what seems to me to be the somewhat more haphazard approach that we have got through some of the divisions of general practice at the moment?

Ms Huxtable —The Building healthy communities report and the role of the Performance Authority is important.

Senator SIEWERT —Sorry?

Ms Huxtable —The Building healthy communities reports are referenced in the Health and Hospitals Network Agreement. So one of the key things here is to have greater transparency about what is happening in a local community and having an organisational structure that has a specific responsibility to understand the needs of the population, what is happening for that population, how that population is faring against other similar populations. So the National Performance Authority, at the most high level—

Senator SIEWERT —Which WA is out of.

Ms Huxtable —Well, as I said, discussions are continuing. The role of the National Performance Authority and the role of the Medicare Locals with respect to those Building healthy communities reports are important points of transparency and accountability about what is happening in local communities. Where gaps have been identified, through those open processes, then very much the expectation would be that the Medicare Locals act and show that they are doing work to fill those gaps, and also that the local hospital networks are. Often what we are talking about here is where people are falling through the gaps—they are leaving hospital and going nowhere, information is not being passed or whatever the case may be. We have had some other discussions about this a few weeks ago.

The other issue is about the funding streams that are available for Medical Locals. They will, in part, drive the early prioritisation of their work. So after-hours is one area that has been identified. Allied health services in respect of diabetes and the aged care money are others. There is also the ATAPS money with respect to people with severe and persistent mental illness that will be going out through divisions but moving into Medicare Locals as they come on line.

Senator SIEWERT —I will put some more questions on notice.

CHAIR —Thank you to the officers from that outcome.

[5.47 pm]