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Wednesday, 24 June 2009
Page: 4107

Senator ADAMS (11:07 AM) —I rise today to speak on the Health Workforce Australia Bill 2009. Health Workforce Australia is a new statutory agency which is being established as a body corporate. It will have $1.1 billion of Commonwealth funding and the state and territory funding amounts to $539.2 million. This is a total of $1.6 billion which will come under the authority of the Health Workforce Australia board. This bill needs to be passed by 1 July so it can commence operations by July 2010. This has come about through recommendations from the Coalition of Australian Governments, COAG.

The Senate Community Affairs Legislation Committee held an inquiry into the Health Workforce Australia Bill, and the concerns that were noted by the coalition senators were a lack of supporting regulations accompanying the bill, the potential for Health Workforce Australia to attempt to usurp the role of professional colleges and other organisations in accrediting clinical education and training for health professionals, and the deliberate lack of involvement of medical and health professionals in the governance of Health Workforce Australia.

Before I move on to the composition of the Health Workforce Australia board, which our witnesses really had more concerns about than any other part of the bill, I would like to say what Health Workforce Australia will do. It will establish more effective, streamlined and integrated clinical training arrangements and support workforce policy and planning. Its responsibilities will include funding, planning and coordinating pre-professional entry clinical training across all health disciplines, supporting health workforce research and planning, including a national workforce planning statistical resource, and funding simulation training. The authority will also ensure best value for money for the workforce initiatives and a more rapid and substantive workforce planning and policy development environment, and will provide advice to health ministers on relevant health workforce issues.

We should look at the description of what health workforce is. It means the body of professionals who are providing or are employed to provide professional healthcare services to Australia in public and private hospitals, private practices and other government and non-government institutions. With that description, it covers an enormous amount of the workforce in Australia. Health is a huge industry and it is terribly important for Health Workforce Australia that all facets of the health workforce have an opportunity to provide advice to this board when it is established. That has really caused huge problems. A combination of factors which lead to difficulties with health include the fact that we have an ageing population requiring greater access to medical services, an ageing and changing medical workforce, lower working hours by health professionals, increasing chronic disease and increasing community expectations. I think the last of those, increasing community expectations, is very real. The community do expect to have world standard health services provided to them, and more and more as technology changes our health professionals are becoming very expert in the areas that they work in. But it also must be remembered that this is a hands-on profession; it is not an automated profession. Therefore our workforce is very important.

I would like to move to the composition of the board that will oversee Health Workforce Australia. Unfortunately, a number of our witnesses felt that it should be a board of management so that all areas were represented, but with the board having numerous members it really would not be able to complete its role in the way it should. So this board, as was finally explained to the committee by the Department of Health and Ageing, is a board of governance. Because of the funding put forward, the $539.2 million from states and territories, the board will have representatives from states and territories numbering eight. These people will be the health commissioners from each state and territory. There will be a chair appointed and a member from the Commonwealth. Then there are three other positions. This has led to a lot of debate because, as you can imagine, the medical fraternity wish to be represented, the nurses wish to be represented, the allied health people wish to be represented. Private hospitals, which do 40 per cent of our elective surgery, wish to be there, and I do not want to forget the aged-care industry, which is becoming more and more reliant upon a workforce and is having a lot of trouble trying to attract people to it. It was explained by the department to the committee that the board was a board of governance, not a board of day-to-day management. A CEO is to be appointed and this person’s job is described in the Health Workforce Australia Bill.

Getting the right evidence and advice from all these different health workforce industries was definitely a problem we raised. The way that was explained by the department was that they would be looking for expert advice. But I note in the explanatory memoranda to the bill there is a clause that states that consultants can be employed. I do hope that the CEO of the board does not go employing consultants and leaving out the expert advisory committees, because having expert advisory committees will really improve the understanding of those board members.

Other questions were asked of how the up to three extra members of the board would be appointed, but we really could not find out whether there would be an advertisement for these three members. It is obviously going to be a board with a mix of skills. Questions I asked were to do with whether there would be financial expertise and legal expertise on the board and whether there would be any input by consumers, which I feel is very important. The CEO and the day-to-day management of the board really do need oversight. If the up to three extra members are not going to be representatives of any of the health workforce organisations, I believe we should have oversight, particularly with a budget of $1.6 billion, with someone on the board who has financial expertise.

These boards are very complex. I had the experience of being a member with rural health service expertise on the Metropolitan Health Service Board in Perth. I spent four years on that board. That covered all the teaching hospitals, the four secondary hospitals around Perth plus mental health services. That board had a budget of $2.4 billion. I know the complexities of being a member on a board like that, so I will certainly be watching the Health Workforce Australia board with great interest to ensure that they are doing the right thing by our huge health workforce. The lack of supporting regulations accompanying the bill was a great frustration to our committee because it is very difficult to pass a bill if we do not know what regulations underpin it.

We are only six days away from the end of June, and I note that the Prime Minister was actually going to fix the nation’s 750 public hospitals by now. I know that there has been some concern that this Health Workforce Australia Bill is the first part of a takeover of the states’ health services. Mr Rudd did promise that he would fix the public health system by mid-2009. I note that the Prime Minister’s website maintained the government’s promise to fix hospitals until December last year when the promise disappeared to be replaced by the wording that the Rudd government would ‘improve’ the hospitals. Mr Rudd told Australians when he went to the election that he had a long-term plan to fix health and that the buck stopped with him. Now he is saying that the National Health and Hospitals Reform Commission will formulate a long-term plan for the Australian health system. I am really very worried about how this is going to work. I do hope that Health Workforce Australia will be part of that plan to fix the health system, but this bill has to be passed by 1 July for Health Workforce Australia to start to do anything by January 2010. So I think the government probably has a question to answer in that respect.