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Thursday, 19 March 1987
Page: 1160

Mr HODGES(4.16) —In entering this debate on the National Health Amendment Bill I find it extremely difficult to settle on any one or two issues that one should address, mainly because we have a Minister who is presiding over a department that is in a shambles, in a complete state of chaos-a Minister who himself is scandal ridden. I believe that he reflects what is happening in his Department. Let me just suggest eight or nine of the matters that come to mind very readily. We have the totally unsatisfactory position that pertains with tens of thousands of patients in this country endeavouring to have elective surgery. That is a scandalous state of affairs.

Mr DEPUTY SPEAKER (Mr Leo McLeay) —Order! I was just reflecting on a statement that the honourable member made when he said that the Minister was scandal ridden. It is a reflection on the Minister and he should withdraw it.

Mr HODGES —Mr Deputy Speaker, if you want me to withdraw it, I will. Another example is the exploitation by some sections of the medical profession-I emphasise, some sections-of Medicare bulk billing. The Minister knows very well that that is costing the nation hundreds of millions of dollars, yet he encourages bulk billing. The expenditure blowout in Medicare is a scandal. The Minister for Health (Dr Blewett) is bringing disrepute to the Pharmaceutical Benefits Advisory Committee by his manipulation of that Committee. The fact that this legislation contains provisions to amend the National Health Act in relation to prescription entitlement cards is also a scandal. I will point that out a little later on.

Pharmpay, the advance payment system to pharmacists, is also a scandal and an outrage. The fast tracking of generic drugs for listing under the pharmaceutical benefits scheme is also a scandalous state of affairs. The Minister stands condemned for what he and his Department have allowed to happen in this regard. The leaking of confidential computer data from his Department is a scandal and an outrage. More recently, in Brisbane, namely within the last couple of weeks, raids on Optical Prescriptions Spectacle Makers Industries Ltd by members of the Australian Federal Police under the direction of the Health Insurance Commission are also an outrage and a scandal that this Minister ought to take a deep interest in.

I want to make a few comments in relation to Pharmpay. The Minister tells us in his second reading speech that clause 11 will provide for the Secretary of the Department of Health to make advance payments to pharmacists. I point out to the House that these advance payments have been made for the last two years.

Dr Blewett —The last 10.

Mr HODGES —In the last two years the Pharmpay method has been used illegally by the Minister's Department of Health.

Dr Blewett —And you used it illegally-for 10 years you have been illegal.

Mr HODGES —I am sorry, but for the last two years that we have had this system operating it has been illegal. It amazes me that a department that had 4,134 staff members as at 30 June 1986-free of the Health Insurance Commission staff who total about another 4,500 and 955 of whom are in the pharmaceutical benefits section, a section that has developed over 40 years of a scheme-can make so many blunders and illegal decisions in a particular area with a payout of some $700m to $800m a year.

The Minister ought to be deeply concerned about the things that are going on within his Department. A legal opinion has been obtained and it has been decided on the advice of the Attorney-General's Department that there have been illegal payouts, so we will have an amendment to an Act. I would have thought that the Minister could have done a little better than that. If he needs to put the cleaners through the Department, he should have the intestinal fortitude to do that. It is an inefficient, bungling and excuse-ridden department. Repetition strain injury is being blamed for delays in the processing. I ask the Minister to look closely at this. I am talking about a system that has been operating for 40 years, a system that is not the making of the pharmacists of Australia, a system that is the making of governments of the past.

Clause 5 of the Bill deals with prescription entitlement cards. This aspect of the National Health Act has been operating for four months. I warned the Minister in this House, when the matter was debated on 24 September, that many loopholes would develop in this system. He told us that 10,500 prescription entitlement cards were issued in Australia after four months. What will the position be after eight or nine months? I understand that far more entitlement cards have been issued than was ever anticipated by the Department. I understand that people are getting low-cost items recorded quickly-in other words, in two or three weeks or months-so that everything from thereon in will be obtainable by them at no charge. It is quite an easy and simple matter to achieve that; there is nothing illegal in it at all.

Why does the Department suspect fraud at the moment? Why have pharmacists been asked, in contravention of the existing Act that the Government is now amending, to return prescription entitlement card application forms and all of the prescription record forms when they have not been specifically requested to do so in writing by the Secretary to the Department, as is contained in section 84e (6) of the current Act? That has been going on for four months in contravention of the Act. As I said earlier, it is an outrageous state of affairs-a department that is riddled with scandal, a department that cannot follow the Acts that it is supposed to administer.

Today, four months later, this amending legislation is before the House. The Minister says that it will give the Department the capacity to audit the issue of entitlement cards in a more timely fashion. What lovely, flowery words to just cover up some problems. That is all it is. Of course there are problems with the system. There were always going to be major problems with the system; yet the Minister says that this legislation will benefit pharmacists. They do not have to keep the documentation for 12 months, as the Act states. They are not doing that anyway now because the Minister's Department has been requiring, coercing, or requesting them, whatever word we like to use, with prepaid stamped addressed envelopes to send in the information-in contravention of the Act because, to my knowledge, there has been nothing in writing from the Secretary to the Department, as contained in section 84e (6) of the current Act.

No doubt we have a blowout in the system. I can imagine the paperwork. I do not know how the 955 members of staff of the pharmaceutical section of the Department will handle the situation when they get tens of thousands of envelopes coming in as we get past the sixth, seventh or eighth month of the financial year. I think the Department has a 14-month financial year in front of it with the introduction of this scheme. I suggest that the Minister look closely at the system and not rely on the minions in his Department, because they will let him down. They have let down previous Ministers. He should stand up to them and look carefully into the matter himself.

I want to move to an issue that I have debated in this Parliament on a number of occasions with the Minister for Health-the 45 prescription items that he deleted from the list last November. I refer the Minister to his repeated statements that those drugs were removed on health or medical grounds because he is on the record so many times as using that specific terminology. In the Canberra Times, in answer to a letter mentioning a Dr David McNicol, who was the Acting President of the Australian Capital Territory branch of the Australian Medical Association, the Minister talked about the recommendations of the Pharmaceutical Benefits Advisory Committee and removing those drugs on health grounds. He also mentioned it in this chamber on 19 August in answer to a question from the honourable member for Lowe (Mr Maher). The Minister stated:

There are three points to be made: First of all the decision was made on health grounds on the advice of the Pharmaceutical Benefits Advisory Committee . . .

In a letter in the latter part of last year he stated to me:

I realise that some of the deleted medicines . . . most affected will be pensioner and concessional groups. Nevertheless, I have accepted the PBAC's recommendations, made on medical grounds, believing in addition that in the current economic climate the community as a whole can ill afford the situation . . .

He also refers there to the economic climate. There are plenty of references to the fact that the PBAC recommended those deletions on health grounds. I turn the Minister back-because I obtained some documents under the Freedom of Information Act-to 1979-80 when the Minister for Health was the honourable member for Gwydir (Mr Hunt). He wrote to the Chairman of the Pharmaceutical Benefits Advisory Committee, who at that date was a Dr M. V. Clarke. At that stage the honourable member for Gwydir said to Dr Clarke that the Government was endeavouring to save $20m in the pharmaceutical benefits area. He stated:

Accordingly it would be appreciated if the Pharmaceutical Benefits Advisory Committee could provide appropriate advice so that the Government may give consideration as to which drugs might be deleted.

It would greatly assist the Government if the Committee could provide a list of drugs and drug groups, rated in order of lowest priority for continued benefit listing, sufficient to enable the Government to make decisions regarding deletions to provide the required level of savings.

That letter was written in August. Another letter from the honourable member for Gwydir of 30 August to the same chairman, Dr Clarke, states:

In this latter regard I appreciate that the Committee may not wish to recommend specific items for deletion from the Schedule; however, as I mentioned in my letter of 21 August 1979, it would be of great assistance to the Government if the Committee would provide me with a list of drugs and drug groups rated in order of priority for continued benefit listing. This list need not be exhaustive, but should be of sufficient length to enable the Government to select from it enough items for deletion to provide savings in Government expenditure in the order of $20 million in a full year.

The minutes of the Pharmaceutical Benefits Advisory Committee meeting of 7 September refer to the fact that the Government had made that request. The Committee's report, among other things, talked about the need for an adequate list of efficacious drugs and so on. Let me quote:

As it is also the responsibility of the Committee to preserve an adequate list of efficacious drugs at reasonable cost, it should be made clear that these drugs are not recommended for delisting, but if the Government delists them it should announce that the delisting decision is that of the Government.

Dr Howell, the then Director-General of Health, in a minute to the honourable member for Gwydir, the then Minister, referred to this fact and to the fact that some of the delistings may cause hardship to pensioners and disadvantaged non-pensioner groups. On the bottom of the minute he noted:

I think that the delisting would be fraught with public peril . . .

He stressed:

The Committee has also stressed that if the Government delists these drugs it should announce that the delisting decision is that of the Government.

That is a perfectly plain request by the PBAC which was again carried forward by the Director-General of Health, the equivalent of the Secretary to the Department today. The then Minister, the honourable member for Gwydir, wrote on the bottom:

Please prepare a submission for Cabinet. I want to ask Cabinet to reconsider this earlier decision. Further, no delistings should occur before 1 April 1980.

He also noted:

In preparing the submission please advise which drugs are important to aged people.

The honourable member for Gwydir was a compassionate and concerned Minister for Health. There is clear evidence that the PBAC was not going to be pushed around, and it was not pushed around because the government of the day made some of the deletions-not all of them-that were in the list.

Let me turn the clock forward about six years to last year and the present Minister for Health. This is the position. This is what shows up through freedom of information. There was a letter from Dr Donovan, the first Assistant Secretary to the Department of Health, to Dr Grigor, the Chairman of the PBAC. In that letter Dr Donovan makes reference to section 101 (4). It refers to a legal opinion that was obtained from the Attorney-General's Department. Do not ask me why a legal opinion was obtained on this occasion; the Minister's Department never seems to bother. The legal opinion stated that the Minister had no right to delete or to add. All right, we accept that. Apparently at some stage an amendment to that section of the Act is to come forward. Why the Minister did not amend the Act at that time and make the deletions himself I will never know. That is best known to the Minister, but he ought to tell the Parliament and he ought to explain to the PBAC why he did not amend the Act at that particular time. I quote from the letter:

It is therefore proposed to amend this section to permit the Minister to remove items from the benefit lists without prior agreement of the Committee.

This letter makes it abundantly clear that the Minister wanted to effect the delistings to save expenditure. I have said in this Parliament and to the Minister that there is nothing wrong with that. It is just the devious way in which he went about it. Again the Minister was hiding behind the PBAC. All the Minister had to do was to make those amendments and delist the drugs he wanted to, and everything would have been in order. Previous Ministers have effected delistings, as I have said, albeit perhaps without being strictly legal, but the fact is that those delistings were done, and done in an honourable way.

I turn to another letter, this one from the Minister to Dr Grigor. The Minister made two requests in this letter. The first request reads:

I ask that at your June meeting you review some benefit items with a view to determining, on health grounds, whether their listing is justified. The Department will be preparing a submission to the Committee on this subject, which will include a list of items for review.

Secondly, the Minister requests the Committee to look at a published statement of aims and guidelines. The final paragraph of the Minister's letter is interesting. It reads:

While I hope that the Committee will commence revising its guidelines at the June meeting, I realise that this task may take some time. I would however request that you finalise your advice on grounds for listing at the June meeting.

It is clear from this letter that the PBAC was being instructed to finalise the listings at the June meeting `on health grounds' from the list prepared by the Health Department. The other request in the letter was not terribly urgent, but the delistings were. The Minister wanted that made clear to the PBAC and, of course, the PBAC did his dirty work for him. I might add that some of the members of the PBAC were most unhappy with those delistings. Going a little further into the documents I have obtained, I will read from a letter from Dr Brian Cowling to Dr Grigor, the Chairman of the PBAC. It reads:

One half day back in my practice makes me sure that the PBAC made a serious error in removing all mild analgesics-aspirin, paracetamol and combinations with 8 mgm of codeine phosphate from the list of benefits.

That letter was circulated to the other PBAC members and, after that was done, Clark Massie, a member of the PBAC and a senior officer of the Minister's Department and a pharmacist by profession, wrote a note to Mr Threlfall on the bottom of the letter. It said:

I spoke with Dr Grigor this morning-I reaffirmed my decision, taken at PBAC, that the original vote of 7-2 put in place a recommendation to delete the said items. In the absence of new evidence I saw no reason to consider the matter again.

Another note from Mr Massie, this one to the Minister, dated 27 June 1986 clearly illustrates the unease of the PBAC members. In this particular minute he says:

Even after the meeting there have been further expressions of concern and discussion between members.

That is, members of the PBAC. Let me top all this off for the Minister. There is a note to the Minister from Dr Donovan of either 1 July 1986 or 3 July 1986-there are two dates on this-and the Minister has noted and signed the letter. The final paragraph of this minute to the Minister says:

You might also like to write to the Chairman of the PBAC along the lines of the attached.

The Committee has really gone out of its way to help in a difficult financial situation.

What a revelation this is. That is beautiful stuff, brilliant stuff-quite conclusive proof that the Minister's medical grounds and health grounds so often stated are just a lot of hogwash. The Minister wanted the decision and he bullied and coerced the Pharmaceutical Benefits Advisory Committee into making that decision-a reputable body in itself that the Minister has brought into disrepute.

Mr DEPUTY SPEAKER (Mr Mildren) —Order! The honourable member's time has expired.