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Tuesday, 13 June 1989
Page: 3863


Senator WALTERS(3.47) —Once again we are debating in this chamber further amendments to the National Health Act. What a shambles the Government's Medicare has become. During the years this Government has been in power we have had 17 different changes to Medicare, not counting the updating of income thresholds. Now we have an additional number before us today. It is about time that the Government realised that Medicare is just not working. Despite everything that the Government has done, or attempted to do, medical and hospital services are rapidly deteriorating, at the same time becoming so expensive that the Government is unable to contain the blowout in expenditure.

Public hospitals are strapped for funds. We have long hospital queues and have had for years. Senator Crowley said that that was a problem, that Medicare had a few small problems. People in those hospital queues do not believe it is a small problem at all. It is just plain bad medicine. We know there have been deaths among people who have been waiting in hospital queues. It is time the Government realised that Medicare and its general philosophy on medicine has to be changed.

The Government in its early days did everything possible to get rid of private hospitals. It socialised three-quarters of the health funds business in the hope that this would sound the death knell for private hospitals. When that did not work, it reduced the Medicare rebate to patients in private hospitals to 75 per cent of the doctors' scheduled fee. If patients had the temerity to want private insurance to pay the additional cost of private contributions on top of the levy they were already paying, the Government penalised them and would not allow them the 85 per cent rebate that patients had received until then.

These gross inequities have caught up with the Government. As Dr Blewett has forced patients out of private insurance and out of the private hospital system, slowly but surely the public hospital system is buckling under the weight. Public hospital queues are lengthening, their costs are escalating and the Government's health bill is skyrocketing. Instead of realising that the Government's whole philosophy is at fault and instead of making appropriate changes, this incompetent Minister applies more bandaids. He is intent on blaming everyone except himself. He has called the doctors every name he can lay his tongue to. Only under Dr Blewett has this country seen nurses on strike, doctors resigning from their jobs, and pathologists taking the Government to court-and, I might add, winning. Only under this Government have we had patients dying before they have been attended to because of hospital queues. Only under this Government have pharmacists closed their doors in protest against government measures. Prior to this the medical and paramedical community worked extremely well. As I have said, further bandaids are now to be applied through this legislation. What a woeful reputation this Government has acquired in such a few years!

The legislation before the Senate deals with several areas. I will describe first the Government's proposed changes to the general practitioners' (GP) schedule fee. I believe this is the first step in a preferred provider scheme. The Government has decided that there will be two types of general practitioners: the good general practitioner and the lesser general practitioner. The good general practitioner will be on the vocational register and the lesser general practitioner will not. The good general practitioner will attract a higher rebate than the lesser general practitioner. As usual, the aim is to cut costs and to help the Government overcome the blow-out in its financing of Medicare. I have only to quote from the second reading speech of the Minister for Community Services and Health (Dr Blewett) to point this out. He said:

In the longer term, the Government expects general practitioners to be more willing to care for more complex conditions within their competence and to be more discriminating in their use of specialist referrals, prescribing and diagnostic tests.

This should lead to reduced costs in the secondary and tertiary sectors and overall a much more effective use of health resources.

Once again, it is not a case of good medicine or otherwise; it is just a case of cutting costs. How will the Government do this? A few minutes ago we listened to Senator Crowley telling us what a wonderful thing a vocational register for general practitioners was. In this Senate we can only debate what is in the legislation. We are being told that there are agreements with the Royal Australian College of General Practitioners, but we do not have that in the Community Services and Health Legislation Amendment Bill. All we will have in the legislation is what is being debated in this Senate. I would like to quote from the Bill because I do not believe that all doctors, no matter which side they are on-whether they belong to the College and agree with it or to that group of doctors opposing the College's moves-understand the position. Under the heading `Vocationally registered general practitioners', we find:

The purpose of this section is to provide for the registration of certain medical practitioners as vocationally registered general practitioners.

It then states:

The Commission is to establish and maintain a Vocational Register of General Practitioners.

It continues:

A medical practitioner may apply to the Commission for registration under this section.

A medical practitioner `may apply' to the Commission. There is no appeal provision if he is rejected. He may apply and he may be knocked back.


Senator Peter Baume —Which clause is that?


Senator WALTERS —I am quoting from proposed new section 3f, which states:

A medical practitioner may apply to the Commission for registration under this section.

It then states:

The application must be made in a manner approved by the Minister.

It states further:

If:

(a) the General Manager of the Commission is satisfied that the Royal Australian College of General Practitioners has certified that the applicant's medical practice is predominantly general practice and that the applicant has training and experience in general practice that make it appropriate for the applicant to be registered under this section; or

(b) the applicant is, in accordance with the regulations, eligible for registration under this section . . .

The medical practitioner can then go on the register. The Bill does not set out any criteria. The Bill purely states that the Royal College can say, `You can be on the register because we think your practice primarily is a general practice and we think it is appropriate for you to be registered under this section'. There is nothing else in the Bill which would safely suggest criteria.


Senator Peter Baume —No appeal?


Senator WALTERS —There are no appeal provisions. The Royal College, which is the sole arbiter, says, `You can be on it and you cannot'. Proposed new section 3f (6) (b) states:

. . . or . . . the applicant is, in accordance with the regulations, eligible for registration under this section . . .

But we have not seen the regulations. I have sought them but they are unavailable. We are being asked to pass legislation in this Senate that says two things: either a medical practitioner can be registered if it is in accordance with the regulations-we have not seen the regulations and we do not have a clue what they are or what would be the correct thing-or a medical practitioner can be registered if the Royal College says, `You are a pretty good chap'. We have not seen any criteria by which the Royal College could abide that state who should be on the register.

We have heard a lot. We heard Senator Crowley stating that she cannot imagine how we could possibly object to this legislation. That is obviously because she has not read the Bill. She has talked about continuing education and about all the highfalutin things where the Royal College has reached agreement with the Government, but we have not seen them. Despite what Senator Crowley might think, this Senate passes only those things that are written in the Bill.

The Minister for Resources, Senator Cook, has all the bureaucrats beside him. Why do they insult the Senate by bringing forward legislation that they know this Senate cannot pass? How could we possibly pass legislation that is so shoddily written and contains no criteria? How do we know what will be in the regulations when the Minister has been so lax as to not have them before the Senate at the appropriate time? How do we know what agreements the Minister has made with the Royal College? They are not in the Bill. We cannot pass things in this place that are not in the Bill. I am not interested in the second reading speech of the Minister for Community Services and Health. He has a number of things in his second reading speech. For example, he states:

A vocational register of general practitioners;

the requirement that for general practitioners to remain on the register they undertake continuing medical education and quality assurance programs accredited by the RACGP;

This is in the Minister's second reading speech but it is not in the Bill. He then says:

In assessing a practitioner's medical practice, the RACGP will have regard to . . .

It is not in the Bill. It is of no use the Minister putting it in his second reading speech. He goes on:

The Government has accepted that fellowship of the RACGP, or an equivalent post-graduate qualification in general practice, should ultimately be the only experience and training which make it appropriate for a practitioner to be placed on the vocational register.

It is not in the Bill. It is of no use the Minister giving a second reading speech that has nothing to do with the Bill in front of us. I have never voted for a Bill that has not set out in detail what the legislation should be. I have no intention of ever voting for a Bill that does not do so. The Minister goes on:

The RACGP has defined part time practice as a minimum of two sessions a week, which the Government regards as a generous provision.

Again, it is not in the Bill; there is nothing in the Bill. He says that the assessment will be on an individual basis against the eligibility criteria. What are the eligibility criteria? They are not in the Bill. There are so many other matters that I would only be wasting my time if I went through pointing them out. This Senate cannot pass legislation when it has no idea what it is all about. The only time the Bill mentions continuing medical education is when it says that if such education is not undertaken, the person will be thrown off the register. There is no appeal to get on the register and no appeal if one is thrown off. There is nothing in the Bill that says what criteria should be used.

The next section is on the pathologists. The Opposition is very happy with that and will pass that section. After all, the pathologists took the Government to court and won. We are very happy that that at least has forced the Government-even though it has been dragged screaming-to do the decent thing. Senator Crowley said that she believed that the GP fee might stop bulk billing. Perhaps the penny is dropping; perhaps the Government has seen the light and will get rid of bulk billing. The Minister has not suggested that; it was referred to by Senator Crowley, so I am not sure whether it is fact or otherwise.

I turn to the question of day surgery beds. The Government is trying to push doctors into using day surgery beds. Doctors are already using day surgery beds to a greater extent than in the past but the decision to do so must remain that of the doctor and his patient. Under this legislation, they are being pressured once again as a cost saving exercise-not as good medicine-to use day surgery beds, which means patients going into hospital and coming out the same day, not staying overnight. They are used when a doctor wants to perform a minor operation on his patient in hospital rather than in his surgery. The doctor must not be pressured. I do not believe that this is the way to go. Doctors are moving that way anyway, but the Government is trying to force the issue. For example, according to the Government, a doctor must have a patient in and out on the same day for a dilation and curettage. If the doctor decides that the medical condition of the patient requires an overnight stay, he then has to fill in forms and put in certificates. This is all the red tape that every socialist government delights in. I could imagine nothing more debilitating for any doctor or his patient than for the doctor to have to fill in forms and write a certificate to make sure that his patient gets proper treatment. There has been very little consultation on that. Indeed, there has been none at all with the medical profession. For that reason we will oppose that provision.

I turn to the reinsurance pool. Despite what Senator Crowley says, the Opposition will support this. But we believe that the health funds are now in such a situation, with the Government already having socialised three-quarters of their business, that a Senate select committee should be set up-not a Senate standing committee, as Senator Crowley understood the decision to be-to have a look at the handling of the health funds.

As I said earlier, this is a bandaid measure. First, the Government tried to send all the health funds broke. Finally, Dr Blewett decided that he would have to do something about it. After all, if one of the big funds went to the wall just before an election, he would not be too popular. So he has put forward a bandaid measure to prop up the funds by putting $20m into a reinsurance pool. The Opposition has always believed in community rating. It has been part of its policy from way back. There should be a requirement for all funds to insure all those who wish to be insured-the young and the old-so that the whole funds shares the costs of those most at risk. In other words, the young and the healthy help pay for the aged and frail. They will be aged and frail one day. As I have said, the method proposed by the Government is a bandaid measure only. It is not the way the Opposition would go. It is only a tide over until after the next election. Senator Crowley is obviously unaware that we will be supporting that particular clause. I do not know how she gets in such a mess with some of the things that she misunderstands. We believe that the matter should go to a committee so that it can inquire into the present situation of the health funds as a whole.

Time will permit me to touch only very briefly on the Aged or Disabled Persons Homes Amendment Bill. Its aim is to change to a needs based application for hostel care. It will provide 60 hostel beds for every 1,000 frail aged in the population. It will also reduce nursing home beds quite considerably to 40 such beds for every one thousand frail aged people. Indeed, this will reduce the present number of nursing home beds by over 25,000. The lack of flexibility is introduced by a provision which prevents the Minister from granting an approval in principle for additional hostel places, with recurrent funding if doing so will cause a maximum number of committee hostel places in States, Territories or regions to be exceeded. That is in the aged care area, and there is considerable concern out there that people will be put out of hostels and nursing beds so that the Government can abide strictly by the Bill that we are debating.

There is tremendous concern out in the community, not only in the aged area but particularly with the disabled. The disabled community, particularly the parents of disabled people, regard the abolition of the hostel beds as a great tragedy. We are told that the disabled should be out in the community, that they should not be in hostels where many could cope. We are told that they would be far better off either in private homes or sharing with other disabled people in one or two-bedroom homes.

The Government has got to understand the great degree of disability and the concerns of parents. I have attended many meetings of the disabled to find that the parents of children, who are gradually getting older and who have been settled in hostels very happily for a considerable number of years, are showing great concern that those children will be put out into the community without the proper support that they believe is necessary. The Government is now very belatedly trying to respond to those concerns in the community. Prior to the last couple of weeks or so, people looking after the disabled in hospitals were told that they had a certain time limit for their changeover. They have been told now that further time has been given to them but there is so little flexibility in the whole of this area that people are very concerned. I think the Government will have to take into consideration the problems that are being expounded in the community.

I now come back to the general mess of Medicare. If the Government has decided that its philosophy is not working, that it will have to stop bulkbilling and that it can no longer downgrade medical services to the people, for heaven's sake it should come out and tell us now and start afresh, and the Opposition will support it. As long as the Government goes on putting bandaids on Medicare it will never make a go of it. I appeal to the Minister to start afresh. We have had 17 amendments to Medicare legislation since the Government has been in office. We have another half dozen now. The Government should start afresh and clear up the whole sorry mess.