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Thursday, 10 November 2016
Page: 2575


Senator O'NEILL (New South Wales) (18:35): I seek to make some remarks this evening on the final report of the Senate Select Committee on Health from the 44th Parliament, Hospital funding cuts: the perfect storm: the demolition of federal-state health relations 2014-16. Can I commence my remarks with a statement from the opening part of the report, which comes from that very significant contributor to public discussion in the field of health, Dr Stephen Duckett, who is the director of the health program at the Grattan Institute. To make my remarks I will need to contextualise his statement. He was speaking about the impact of the 2014 budget, and this is what he said:

The 2014 budget did serious damage to Commonwealth-state relations and the confidence with which states could plan and manage health services. It did this by abrogating an agreement about public hospital funding which had been signed by governments of all political persuasions and unilaterally imposing a new funding model on the states.

It is in that context that we are now receiving health care across the country that, as documented in this report, state by state and territory by territory, reveals a crisis of care because of an abrogation of responsibility under the leadership of Mr Abbott, which has not changed very much at all since the change of leadership.

Senator Polley interjecting

Senator O'NEILL: As Senator Polley has indicated: yes, we have a Leader of the Liberal Party and the Liberal-National Party coalition, who speaks the same language as Mr Abbott, wears a different suit—in fact, I am finding it pretty hard to imagine Mr Turnbull in his leather jacket these days. He seems to have discarded it well and truly. However, I want to go to the state of New South Wales, in particular, to put on record the committee's view about that particular state. It is the most populous state in Australia, and the committee concurred that New South Wales faces a crisis as a result of these coalition government hospital funding cuts. It is by forcing the state to scrape together funds year to year for hospital services because of the federal government cuts that make forward planning virtually impossible.

Without the ability to invest with long-term certainty in the health-related infrastructure and training a state government's ability to make a hospital system more efficient is severely curtailed. We made remarks that, from what we could see, the New South Wales government was absolutely unable to sustain the increased need for adequate hospital services without those contributions from the Commonwealth that were simply withdrawn arbitrarily. Agreements that saw the states and the federal government under Labor leadership agree to a shared responsibility model for looking after health care were ripped up. What that has led to is a severe impact on clinical effectiveness and patient care that is delivered in our hospitals.

I particularly want to refer to some of the crises that have been reported in the course of this year in New South Wales, including failures that were documented very clearly in the quarterly reports of health data but also in the public space in our media. The people of New South Wales are aware of the scandal of chemotherapy underdosing that has now been documented and revealed—after what would seem to have been fair attempts at hiding it—at none other than St Vincent's hospital. That very highly regarded institution does indeed do very good work, but underdosing of chemotherapy is something that shocked the community. It has become more shocking, in terms of the scale and expanse of that practice, with chemotherapy underdosing at St George and Macquarie University hospitals as well as the clinics in Orange and Bathurst. I am very aware that the people of Orange and Bathurst are not so far from Sydney that they cannot get there. But when people are unwell they do rely on high-quality chemotherapy and radiotherapy in the area in which they live. Sadly, this underdosing that we have seen in Orange hospital is a very major concern.

Professor Frankum gave evidence to the committee in November 2015 that was very important. Just for the record, at the time he gave evidence, Professor Frankum was the vice president of the AMA for the New South Wales branch. When he spoke to the committee he said that the scale of the cuts in New South Wales between 2017 and 2024 would have a terrible impact. He said:

That is short enough that the effects will be felt keenly and immediately but long enough to be sufficiently insidious that the true cause would be masked by the political cycle.

The depth of the impact of this is very, very important. He was backed up by Dr Andrew Pesce and Dr Antony Sara, who also gave evidence. In response to the question of whether the priority was to save money in these hospitals, they made these comments:

Dr Pesce: Yes. If the priority is to save money, it is very hard to reform the system.

Dr Sara: It becomes impossible. Essentially, the managers and doctors in those hospitals and districts go into further spiralling into a pit of despair. You would be unable to do any of the strategic planning stuff [workforce planning and infrastructure] that [Dr Andrew Pesce] has talked about; it just becomes a race to the bottom. That has been happening in South Australia over the last couple of years, and it is a nightmare. They are not looking at reconfiguration, they are just looking at slashing and burning. Then people start thinking about their jobs. They start thinking about which patients gets the care and which do not—

Let me just restate that evidence given to the Senate committee by a doctor, Dr Sara, working in New South Wales, describing the impact of the cuts and the interaction of those federal cuts with state health care. He said people in hospitals 'start thinking about which patients gets the care and which do not'—

Any rational basis for planning delivery of health services just goes out the door.

We are seeing, in places like Orange, the reporting of chemotherapy underdosing. That is just a symptom of a system that is now under so much pressure because of the removal of adequate funding and the abrogation of responsibility of this Liberal-National Party government that our friends, our families and people seeking health care in our hospitals are now at risk. I am sure people would be very alarmed to think that doctors are making decisions about who gets the health care and who does not. It cannot be any clearer than decisions where people need a particular dose of chemotherapy and they are underdosed. The sorts of pressures that are being applied to our highly trained workforce of professional health carers is absolutely unprecedented in our history.

Concerns such as those expressed by Dr Sara were actually echoed by Dr Keat, who also gave evidence to the committee. This is a description of the delays in care that are beginning to happen now:

We have patients who need muscle biopsies to make a diagnosis for changes in treatment or for aggressive treatment we need to give but we need a bed for that because it needs anaesthetic but we cannot necessarily book that patient in for an elective procedure which would save hospital beds to a degree. We know if it is going to happen that day, we will bring the patient in that evening. The next morning they have the procedure and potentially go home the next evening. We cannot plan that well. We tell the patient we will give them a call if there is a bed available in maybe a week or two weeks. As it goes on, the patient becomes weaker or we cannot initiate the appropriate treatment in time and they may end up in hospital and a vicious cycle develops.

What we heard about, in the evidence that was received by the select committee, is echoed across the country. I am certainly looking forward to making further remarks about other states that have delivered very important information about the breakdown of health care for Australians that is happening because this Liberal-National government, under Malcolm Turnbull and under Tony Abbott—seamlessly under both of them—has failed to adequately fund hospitals.

We are seeing pressure on doctors to service their patients inadequately. We are seeing pressure on hospitals to fail to provide beds in a timely way for basic care in accordance with established protocols. That is a crisis in health care that is not just about the dollars; it is about the people, it is about their patient care and it is about their rights to decent health care in this country. I seek leave to continue my remarks.

Leave granted; debate adjourned.