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Wednesday, 7 February 2001
Page: 24125


Mr SNOWDON (5:45 PM) —I am pleased to be able to participate in this debate this evening and to point out that the Health Legislation Amendment Bill (No. 3) 2000, whilst in some ways well intentioned, does not address the health care needs of rural and regional Australians, certainly not the people who live in my electorate. It should come as no surprise to the government that I should be saying this, because they ought to know what the situation is in relation to health care for people in the Northern Territory, particularly those people who live in remote communities.

The major element of the bill is, as others have pointed out, to amend the National Health Act 1953 in a way which will protect health insurance funds from legal proceedings if they disclose patient information to a day hospital so that the facility may provide the patient with informed financial consent. It will enable the private health insurance industry to provide insurance cover for the cost of outreach services as a substitute for hospital care. The range of services covered will be defined by ministerial discretion. This can already be done for non-medical services for those people with ancillary insurance and is in line with trends towards short hospital stays and increased emphasis on post hospital care in the home.

Madam Deputy Speaker Kelly, you would be aware from your electorate that people who live in regional and remote communities away from metropolitan centres have very little of the luxury of access to home care. Indeed, in the case of the Northern Territory the number of public hospitals is small and there is only one active private hospital. So the ability of even privately insured patients in the Northern Territory to access services out of hospital is difficult at the best of times, impossible for many.

But of course this does not address the real issues that confront the people in my electorate who are not fortunate enough to be either wealthy enough or indeed in some cases healthy enough to have access to private medical insurance or private medical facilities, because nothing in this legislation contemplates the needs of those people who live in regional and remote communities. As we know, and particularly in the case of the Northern Territory, by and large these remote communities are inhabited by indigenous Australians, who have the worst health outcomes in the nation. As we know—just as an indicator of the appalling health statistics which are prevalent within the indigenous community—life expectancy for Aboriginal males is nearly 20 years less than the life expectancy for Australians in general. Whilst this is a very crude example of the state of Aboriginal health, it is an issue which, as we know, remains a cause of national shame.

Although I have to say that the Minister for Health and Aged Care has been involved in implementing and initiating some quite good policies in the area of remote health, currently there is absolutely no doubt that indigenous Australians are not able to stay at home and are being forced into cities and regional centres, away from their family and community, for their health care needs. This, of course, is true not only of indigenous Australians but also of non-indigenous Australians living in remote communities.

The government asserts that by introducing this bill and encouraging home based care it recognises the need to treat patients in their familiar surrounds to decrease the risk of infection, lower the cost of health care and free up hospital beds. I just make the observation that for the very large proportion of those Australians who live beyond the reaches of metropolitan areas, those with extremely limited access to even the most basic health care services, the aims of this bill are indeed fanciful.

The government has rightly recognised in the introduction of this bill that treating patients in familiar surrounds is extremely important. If it is important for the general population, how much more important is it for indigenous Australians in their home communities? I ask this seriously because—as indigenous Australians do demonstrate the worst health profile of all Australians, they often live in abysmal conditions and their circumstances are often in many places quite deplorable—we know that, whether their health is good, bad or indifferent, their wellbeing depends to a very large extent on them staying in their country and close to their extended family networks. Indeed, I think it is fair to say that their chances for successful treatment and recovery may be fatally compromised in an alien environment such as a hospital in an urban centre that may be hundreds and in some cases thousands of kilometres away from their country.

We cannot and should not underestimate the importance of this factor in maintaining people's wellbeing and assisting the treatment process. It is fair, I think, to argue that for many indigenous Australians the prospect of leaving their country for treatment or for extensive stays away from their community in hospital or other treatment centres is a cause of trauma and heartache. There are often quite significant cultural and other ramifications because of the dislocation they experience. Some, sadly, may even die.

I am pleased to say that there is, and there has been over recent years, increasing recognition of the need to decentralise the delivery of health services to remote indigenous Australians. As a result of initiatives first put in place by the Keating Labor government as far back as 1996, through coordinated care trials in the Northern Territory and as a result of further advancements undertaken in consultation with indigenous Australians by the minister, there are now proposals on the board to provide a range of mechanisms for delivering health services to remote Aboriginal Australians in a culturally appropriate way, specifically to meet the needs of their communities. For all the support that the government may have given to coordinated care trials in the Katherine West region, the Tiwi Islands or Miwatj Health in addressing local health problems, I am afraid to say that the government still fails to understand that one size does not fit all in regional and remote parts of Australia. I say this because I am concerned and, in fact, quite alarmed at the patronising insensitivity shown recently by the minister for health for a community based health care initiative in my electorate.

The people of Kintore, on the Territory-Western Australian border, have decided that they want to treat renal failure within their community and not send people off to Alice Springs hospital or elsewhere. They are not asking for anything unreasonable, nor are they asking for charity. To help translate their wishes into action, they held an art auction that raised more than $1 million. If it were the community of Narrabundah here in Canberra, or of Ipswich in Queensland or, dare I say, the local community of Toowoomba in the electorate of the honourable member opposite that raised $1 million for a dialysis unit in their community, they would be praised highly by the government and no stone would be left unturned to ensure that they got what they wanted. It is not the case in this instance. You would think that this government, coming from the philosophical position that it purports to have, would applaud, support and even attempt to promote this initiative as a shining example of the government's so called philosophy of self-empowerment. It seems, however, that you are only allowed to empower yourself if it accords with the way the government wants to do things.

The minister for health, I am sad to say—indeed, I am not pleased to report this to this house—has dismissed out of hand the idea of a stand-alone renal dialysis facility for Kintore. In an interview on ABC radio on 25 January, he said:

A renal dialysis unit is an enormously difficult thing to maintain. Keeping sterility, keeping the technical skills up. It is something that no-one in the world has ever been able to make work in the desert. I understand the people of Kintore wanting it but there are enormous difficulties because it would be a world first—

and he chuckles during the course of the interview—

if it worked.

Not only is this statement patronising, not only is it inaccurate—because it is clear that home dialysis is working successfully in the Bidyadanga community in the Kimberley and other communities through the region as a result of an outreach program run by the Kimberley Aboriginal Medical Service—it has left the people of Kintore with nowhere to go. It has crushed initiative with no discussion of the options. There are alternatives to a fully equipped dialysis unit, such as happens in the Kimberley, although that may not be the only workable option. There could be negotiations with the community to get one. There is no question that there may be problems getting such an enterprise under way but these can be negotiated and worked through. People can be skilled up to do the work and infection controlled premises may well be made available. But no, the health minister cut off all discussion and said it could never be done.

This is an example of the government's inability to come to grips with the needs of people who live in regional and remote Australia. Anything that is away from Dubbo, Traralgon or Toowoomba might as well be on the moon as far as members of this government are concerned. It also typifies the government's total lack of understanding of the real needs of remote Aboriginal Australians and their communities and the government's unwillingness to listen to anything that they do not want to hear. The people of Kintore did not come to this decision lightly. They see family members suffering from renal failure and they are distressed to lose them even temporarily to Alice Springs. Often, when they do depart to Alice Springs, they never return. They came to the rational decision that if they wanted it badly enough, they had to show willing. They raised the money and asked for support only to have it thrown back in their faces.

We often hear about the term `practical reconciliation', but it is increasingly clear that this government is only comfortable when it can impose. It simply cannot cope when people stand up, express their wishes and back it up with action.

Commenting on this question of whether or not the dialysis units could run in a place like Kintore, the Alice Spring News quotes Associate Professor Mark Thomas of the Royal Perth Hospital on their remote area dialysis program as follows:

Starting in 1989, the program assists 54 Aboriginal patients in remote areas, the most remote living at Kalumburu. 47 of these patients are on peritoneal dialysis—using a tube to feed sterile fluid into the stomach four times a day. The remaining seven are on home haemo dialysis, which means they use a machine and which Dr Thomas says requires “spouse, house and nous”. This means a trained helper (three months) and a room with power, water, drainage, temperature control and security.

Dr Thomas says while the requirements are complex, people usually find “creative solutions” given the only other choice of going to a city for treatment. Urban centre treatment costs between $30,000-$60,000 per patient per year, and bush costs are only about 25 per cent more expensive. Set-up cost in remote locality is $12-20,000, plus $5,000 for a water treatment plant, provided the other services are in place. Dr Thomas says the success rate is “surprisingly good”.

Aboriginal medical services report that the Commonwealth has another blind spot in its understanding of the needs of disabled Aboriginal people in remote communities. It does not know how many disabled people there are, what sort of treatment may be available, what kind of housing needs people have and what problems of access they might have. This is just a further example of the failure of government to come to terms with its responsibilities in providing appropriate health services to people who live in regional and remote Australia.


Mr Hockey —That is not true.


Mr SNOWDON —I do not know how I would refer to this bumptious character at the table.


Mr DEPUTY SPEAKER (Mr Hollis)—You have three minutes to go. Don't waste it with arguing.


Mr SNOWDON —I am pleased to; I enjoy the repartee. This is a person who would not know where Kintore was, let alone what the state of Aboriginal health is in that community, or have any familiarity with the question of why people require dialysis treatment in their home communities. He might also ask the Northern Territory government and the Commonwealth government why they force people living in Tennant Creek, where they have a hospital which could be outfitted with dialysis machines, to go to Alice Springs for dialysis treatment. As the Minister for Financial Services and Regulation, he might just ask what the external costs might be of that little exercise and what the benefits might be of providing the service at home—what cost savings there might be. So before he tries to intervene in these debates with his uninformed and ignorant comments, he might actually find some detail and get some facts.

It is important that we provide the capacity for people to have home care. Of that there is no doubt. But this legislation and the moves that have already been taken by the government in terms of public hospitals do very little to assist those people who live in regional and remote Australia. As I have had cause to say previously in this place, what I regard as a rort in private health insurance in this country has had very little positive impact on the people who live in the bush. They do not have access to private hospital systems or to the standard of private hospital care that is available to people who live in, say, Canberra, Melbourne or the shadow minister's own electorate. Yet nothing is being done by this government to assist those people living in these regional areas to get access to the same quality of care and the same services in their communities and their homes which this legislation seeks to make available to people in the general population. The example I have used of the dialysis machine at Kintore is a case in point. There is an opportunity for the government to show its bona fides. It has chosen not to do so; it is time it did.