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Wednesday, 2 March 2011
Page: 1007

Senator FIERRAVANTI-WELLS (5:48 PM) —I was talking earlier about the absence in the National Health and Hospitals Network Bill 2010 of clear delineation of the particulars of enforcement methods, which was raised as part of the Community Affairs Legislation Committee inquiry and the minority report of coalition senators. I want to continue with regard to what sanctions or rewards the commission may use to achieve the desired standards of health. There was also some concern that those standards needed to be set in context for some healthcare providers facing the particular challenges of remoteness and distance.

With regard to tests of clinical performance to be employed by the proposed commission, concerns were expressed that they were inadequate and that the commission proposed to use the very screening that failed to detect the clinical performance of Jayant Patel at Bundaberg Hospital. Other concerns raised were about the make-up of the commission board, the wording of the bill and the absence of explicit references to key stakeholders that the proposed commission should consult with. Some submissions expressed concern that the legislation as it stands does not make it clear as to whether the board would include consumer representatives or even key healthcare professionals.

Accordingly, the coalition made two key recommendations: given the cost, the lack of focus and unclear governance, and the potential for duplication, the coalition urged the government to withdraw this bill; but, if the government persisted, the coalition strongly recommended that this legislation to establish the commission be deferred until the legislation for and purpose of the Independent Hospital Pricing Authority and the National Performance Authority had been fully developed.

In other words, this is another classic example—one of many—of the ramshackle way in which Minister Roxon and this government have approached health and health reform. I do not know how Minister Roxon had the front to turn up to the health ministers meeting in Hobart last week. Her position as Minister for Health and Ageing surely must be untenable at this point. The spectacular policy reversals that have become the hallmark of the Rudd-Gillard government, and now of Ms Gillard herself, have been nowhere more evident than in health, where core elements of Rudd’s so-called reform have been dumped and elements that were previously discarded reinstituted—though, quite frankly, we do not know what is still on the table and what is not because at the moment all we have is an agreement for an agreement; we do not actually have a signed agreement.

Mind you, we did not have a signed agreement under mark I anyway. It was very clear that within weeks of the mark I proposed health changes being ‘agreed’ to, the ink was barely dry before Mr Rudd, in what can only be described as a very cynical move, on the eve of the press gallery ball, dumped the national funding authority, which was part of the COAG red book—there it is at page 49 in black and white. It was the centrepiece of accountability and transparency for the COAG health changes mark I, yet the ink was barely dry when the then Prime Minister just dumped it.

Minister Roxon went out there and said: ‘Oh, no, it is inappropriate. We have talked to the states now. We don’t really need it.’ They did not need it, and now all of a sudden we have the national funding pool re-emerging in mark II. Something that was wrong last year is now right. So was Minister Roxon right or wrong last year? Is she wrong this year? This minister does not know what she is doing. I am not surprised because this whole thing is not really being driven out of the Department of Health and Ageing; it is actually being driven out of the Department of the Prime Minister and Cabinet—just like what happened under Mr Rudd.

Mr Rudd was the organ-grinder while travelling to those 100 so-called consultations. They were only whistle stops at hospitals because they sometimes did two or three in a day to give Mr Rudd and Ms Roxon the opportunity to dress up in a doctor’s coat and a nurse’s outfit while pretending that they were consulting and doing something about health. Those consultations were only about getting photo opportunities. As part of that they wasted $13 million selling a false message of ‘federally funded, locally controlled’. We know that was all about political spin.

We also know that tucked away in the fine print of the first agreement was a little line that said that the clinical expertise for local hospital networks was to come from outside the local hospital network wherever it was practical. What does that mean? It means that the doctors on the local hospital networks would come from outside the local hospital networks. That just beggars belief. The whole thing was built on a false premise and a false message about federal funding and local control. Forget what they were talking about last year with federal funding—that has gone out the door as well.

Ms Gillard’s vote is now falling and she desperately needs to sort out the mess of Labor’s first term. She is conveniently blaming everything on Mr Rudd. She is revving up this issue about the GST clawback by trying to blame the Western Australians, even though Mr Rudd did not have an agreement in the first place. She is trying to rev this up because she needs this basic PR manoeuvre. She is now trying to sell us ‘historic reform.’ Labor has been talking about reform in health since 2007. Remember the 2007 promise from Prime Minister Rudd, ‘We are going to fix the hospitals by 2009 or take them over’?

In 2007 Mr Rudd was berating the then government for not providing enough aged-care beds and saying that people were becoming bed blockers. ‘Bed blockers’—this is how Mr Rudd referred to older Australians who were forced to go into hospitals because, according to him, there were not enough aged-care beds. What actions did he take after that? This government took $276 million out of highly needed beds in residential aged care and shunted them off to long-stay hospital beds. What happened to Labor’s 2007 policy of improving the transition between hospitals and aged care?

According to Catholic Health Australia, every night there are 3,000 people who sit in hospitals who would be better cared for in aged-care homes. Prime Minister Gillard and Mr Rudd have not delivered. If you are talking about real health reform in this country you cannot have real health reform if you do not include aged care and mental health. We trawled through this in the COAG inquiry.

Senator Polley —What did you do in 11 years? You did nothing on aged care.

Senator FIERRAVANTI-WELLS —Just go back, Senator Polley, and see how Professor McGorry and all the other experts berated you—and continue to berate you—for your lack of attention to mental health and ageing issues in this country. Your basic problem is that you see ‘reform’ as photo opportunities in hospitals. You then put those on your My Hospital website to pump all around the country so that you can be seen as if you were doing something. In effect, you are really not doing anything. All you have to do is go into your state hospitals. Come to New South Wales and have a look at the hospitals there.

In the end, you had concerns. In the first COAG red book you set out the need for a funding authority. You needed a funding authority for transparency and accountability because you were concerned that state governments would not use the money as they should. So what did you do? You dumped your national funding authority. You have now come out with this funding pool. We do not know what this funding pool is going to be. Your department does not know. It cannot tell us what Medicare Locals are going to do. You have 5,000 people sitting in the Department of Health and Ageing and they still have not worked out what Medicare Locals are going to do or what these authorities and bureaucracies are going to do.

What is very clear from the agreement mark I and the agreement mark II is that very little will change—the states will still be in control. Despite whatever spin you try to put on this and whatever public relations manoeuvres you try, this is no actual deal and it is certainly no historic reform. You have merely revived the promise to the point where the same lines are now being delivered by Prime Minister Gillard instead of Mr Rudd.

Let me take you back to last year. There was Kevin Rudd boasting that we had agreed to the biggest reforms to the health system since the introduction of Medicare. One year on, this Prime Minister has the audacity to proclaim an agreement to reach an agreement. That is all this is: an agreement to reach an agreement—a photo opportunity so that she can say that she is doing something on health. It is all about political spin, especially when you compare it with the real reforms that not only were promised but also were delivered by the likes of Prime Minister Howard, Prime Minister Hawke and Prime Minister Keating.

Lets us try to look at this watered-down version of what she is trying to pass off as ‘reform’. It looks like Ms Gillard has again overpromised. There is an enormous amount of detail to be sorted out and contested. The government said it was going to have one-stop shops for older Australians. It cannot even deliver a simple thing like one-stop shops. It has been talking about it for three years and it still cannot deliver something that simple. How is it going to deliver by 1 July all these grand promises that it makes? The reality is—and you only have to look to the health commentators in this country to see it—that, just like mark I fell apart, mark II in my view will end up falling the same way. Mark I left so many details to be worked out and when the ink was barely dry it started to fall apart, and it started to fall apart with the National Funding Authority being dumped.

Patients all around Australia are fed up. As I said, you have only to go to a New South Wales hospital to see how bad the system is. In any case, the government is promising all of this $16.4 billion, but it is somewhere down in the never-never. By the time the government actually delivers, it will be 23 years from 2007, and that is a disgrace.