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Community Affairs Legislation Committee
29/05/2018
Estimates
HEALTH PORTFOLIO
Department of Health

Department of Health

[09:04]

CHAIR: I welcome Senator the Hon. Bridget McKenzie, representing the Minister for Health; and officers from the Department of Health. Minister, do you have an opening statement?

Senator McKenzie: No, I don’t.

CHAIR: Ms Beauchamp?

Ms Beauchamp : No.

CHAIR: In that case, we will get started straightaway. Senator Watt, you have the call.

Senator WATT: Thank you. Welcome, Minister and Ms Beauchamp. I would like to kick off today by talking about five saving measures in the budget. The ones that we were able to identify were $416 million from GP visa changes, $336 million from increased use of generic medicines, $190 million from the MBS review, $78 million from improved use of blood products and anti-rheumatic drugs and $40 million from MedicineWise and the National Return of Unwanted Medicines project. Have I missed any savings measures that were announced in this year’s budget, apart from those five?

Ms Beauchamp : I think all of our savings and expenditure measures are listed in Budget Paper No.2. We can go through them line by line, but there are many. I think you have absolutely focused on the more substantial ones, yes.

Senator WATT: We'll get into more detail about those particular savings measures in the relevant outcomes. I just want to talk about it from a global perspective. What is the net saving from those five measures—that is, GP visa changes, increased use of generic medicines, the MBS review, improved use of blood products and anti-rheumatic drugs, MedicineWise and the National Return of Unwanted Medicines project?

Ms Beauchamp : I'll let Mr Wann go through those in details, but one of the things that you have looked at is the MBS review, for example. Any savings from the MBS review has gone back into providing for additional expenses under the MBS. In total, I think there are quite significant increases in MBS expenditure over the forward estimates.

Senator WATT: I'll come to the issue of redeployment of those expenses in a tick.

Ms Beauchamp : Are you just wanting the savings?

Senator WATT: Yes. My calculations work out to over $1 billion in savings from those five measures. Does that sound about right?

Mr Wann : That would be the order of it. We are just trying to work through it. In terms of the visa arrangements, that's actually a Department of Home Affairs measure. It does have an impact on the health portfolio through the MBS and PBS.

Senator WATT: My understanding is that that measure, while it might be introduced by Home Affairs, is going to deliver savings of about $416 million in your department.

Mr Wann : That sounds about right.

Senator WATT: And then $336 million form the generic medicines, $190 million from the MBS review, $78 million from blood products and $40 million from MedicineWise. So all up we are talking about a net saving of over $1 billion.

Mr Wann : That sounds about right.

CHAIR: We have had a request from a photo journalist to take some photos. I assume that the committee is comfortable with that. Information has been provided.

Senator WATT: Sure.

CHAIR: So no documents on the desk et cetera. I’m sure you know the drill.

Senator WATT: Turning to the point you made, Ms Beauchamp, about savings being reinvested, the budget papers do say that the government will reinvest or redirect these savings within the Health portfolio. What exactly does that mean?

Ms Beauchamp : I think when you read the budget papers it is very clear that expenditure over the forward estimates is increasing quite substantially across the whole of the Health, Aged-care and Sport portfolios. So any savings through things like the MBS review or the ones that you have identified have gone back into the provision of additional expenditure items that have been announced in the last budget. When you look at the budget announcements, I think there was an extra $12.4 billion of expenditure across the portfolio, bringing our expenditure for 2018-19 to $99 billion.

Senator WATT: Are you able to point to particular new programs that those savings are being used to support?

Ms Beauchamp : I can go through each of the 90 measures or so that were announced in the budget.

Senator WATT: New measures?

Ms Beauchamp : There were a number of new measures in that. We did provide quite a substantial budget summary to most of our stakeholders so they know exactly what has gone in the budget papers. I am happy to work through those.

Senator WATT: Maybe, for the sake of time, you could take on notice the new programs that are receiving funding from the reinvestment of savings.

Ms Beauchamp : That has all been publicly announced as, obviously, part of the budget process. Budget Paper No.2 and our portfolio budget statements, up the front, has each of the budget measures. But I can certainly provide a summary of new expenditure programs.

Senator WATT: That would be great. At the last estimates, Mr Cormack argued that savings were being reinvested back into the budget bottom line for health. Is that essentially your argument now?

Ms Beauchamp : When you look at the budget process for the portfolio, obviously when you do go through the budget processes—and government makes a lot of decisions across government—the bottom line is that additional money has gone into the portfolio for a number of programs. Indeed, when you look at the whole of government bottom line, there is additional expenditure going into the whole portfolio.

Senator WATT: Isn’t it the case, though, that that increase in funding would have happened anyway as a result of population growth and increased service use?

Ms Beauchamp : There are absolutely new expenditure measures aside from changing parameters and population and growth that you have mentioned, yes.

Senator WATT: These new measures and initiatives that are not simply about increased demand for services, what is their total value?

Ms Beauchamp : I would have to take that on notice.

Senator WATT: Would it be more or less than the $1 billion in savings generated?

Ms Beauchamp : When you look at the expenditure, particularly around aged care workforce PBS, it would be much greater than the savings.

Senator WATT: So new measures that weren’t in existence last financial year that are now in existence this coming financial year?

Ms Beauchamp : Yes.

Senator WATT: The value of those is higher than the $1 billion you have saved?

Ms Beauchamp : Yes.

Senator WATT: Yes. So you are saying that the increase in funding that is going to your department is not simply a function of increased service use?

Ms Beauchamp : It is a combination of changed parameters plus looking at new expenditure items, yes.

Mr Wann : There are some complications with this particular fiscal update in relation to, for example, the PBS. So in that area there was a change in rebate arrangements which dropped the appropriation quite significantly over the forward estimates. But it also dropped the revenue over the forward estimates. So in terms of net fiscal impacts, it was by and large neutral. But it shows a significant reduction in the appropriation for the PBS going forward.

Senator WATT: So there is actually a reduction in the appropriation, or funding, for the PBS going forward?

Mr Wann : In net terms, no. But in terms of the amount being appropriated by the department, yes.

Senator WATT: That is because some of these savings that you have generated in other measures are being redirected into things like the PBS?

Mr Wann : No. I am not the expert in this area. Under the special pricing arrangements, what used to happen—and we still do this but it is being phased out as a result of this measure—was that the published price was different to the effective price. The difference was returned to us as revenue. In layman’s terms, what the measure does is remove, I guess, that flow of cash, and it reduces the amount paid to closer to the effective price, taking out the revenue. I can say that it is artificially dropping the appropriation, but the drop in appropriation is offset by a drop in revenue. So in net terms, the actual amount that is being paid in a real sense is the same. What that does is distorts the appropriation going forward and distorts the health spend going forward.

Senator WATT: Mr Wann, let’s say for argument's sake that, due to an increase in demand for services in the coming year, under the existing formula, that would require, let’s say, an increase of $1 billion in funding. I have just picked that figure out of the air.

Mr Wann : Sorry, for which program?

Senator WATT: In an overall sense. For the department overall.

Mr Wann : Sorry, yes.

Senator WATT: Let’s say because of increased service demand, whether it be through the PBS, the public hospitals or a range of things, the funding required to meet that level of service would increases by $1 billion next financial year. Isn’t it the case that these savings that have been generated—these $1 billion in savings—are used to cover some of that increase?

Mr Wann : Yes. Putting aside the issue around the PBS, yes.

Senator WATT: Okay. That is correct. Then the requirement for increased spending in the budget as a whole, across the entire government, is lower because of these savings that are being used. Savings aren’t adding to the amount that is being spent on health. They are helping cover the increased cost that is going to happen anyway.

Mr Wann : It is a combination. Those savings go towards, as per the government’s fiscal strategy, paying for policy decisions that result in an increase in expenditure.

Senator WATT: Just to be clear, then, those savings that you have generated are being used to at least partly pay for the increased funding to meet increasing demand for services?

Ms Beauchamp : And new expenditure.

Senator WATT: And new expenditure. That is what I said: at least partly.

Mr Wann : It is principally to pay for new policy measures. For example, the PBS is $1.4 billion in new listings. In the aged care package it is a substantial figure that has to be paid for in workforce and the rural strategy. They are all significant spends. There is a bit less in sport because it is a smaller appropriation. And new Medicare listings; all of those together. The three main packages would be aged care, the PBS listings and workforce. But there are lots of other smaller spends—mental health, Indigenous—

Senator WATT: Yes. We will get into those individual measures in the relevant outcomes. One of the reasons I was asking—and I don’t know if you saw this—was because there was an article in the Australian Financial Review on May 11 written by Andrew Tillet. I will come to that article more generally soon. But that had a quote from the minister’s spokesperson, who said:

Both Medicare and public hospital funding are activity-based and respond to the number of patients accessing these services…

I took that to mean that they were the primary drivers of increased funding for your department, but is that not the case?

Mr Wann : It is, but there are also past policy decisions—for example, the re-indexation. Again, I am not an expert in this area. You would have to talk to the relevant policy area. But with MBS indexation, for example, it was a staged implementation. I think it was 1 July 2017 and then 2018, 2019 and then 2020. There are new elements to that. The policy changed back at the last budget. They come into effect and then what they do is, at each point, combined with parameter changes and the like, they have an impact on the shape or the profile going forward. For example, the MBS is a very strongly growing program. Its nominal growth is on average 5.2 per cent per year. That is a strong contributor to the overall spend. Similarly, with hospitals and aged care, which is growing on average 6.1 per cent per year. There are other programs that are demand driven, as you say, that are a bit flatter. But by and large, in terms of health overall, it is growing at 3.2 per cent. That is whole of government—health, aged care and sport taken together.

Senator WATT: Well, let’s get into some of those increases. I want to take you to an objective measure of the government’s claim that health spending is increasing, and that appeared in that article I just referred to by Andrew Tillet in the Australian Financial Review on May 11. I have a copy of that here if it is needed. That article quotes from an extensive analysis.

Senator McKenzie: Yes, that would be great.

Senator WATT: Sure. The headline is, 'Poor diagnosis for budget's health spending'. Just so we can keep it going, why don’t I pass over the one copy I do have.

Senator McKenzie: I’ll meet you halfway.

Senator WATT: Don’t make it a habit. You may not do that later in the day. I’m sure you have seen this article and the report that it refers to. The article quotes from an extensive analysis of the budget conducted by experts at the Macquarie University’s Centre for the Health Economy. Have you seen that article before?

Mr Wann : Yes.

Senator WATT: You will remember that that report found that growth in health expenditure in this budget was in fact 2.1 per cent compared to 5.1 per cent last year. Is that accurate?

Mr Wann : We do have an area in the department that focuses on these sorts of analytics. They have undertaken an analysis of that. They are probably best placed to speak to it. But, broadly speaking, the department did try to replicate those findings. There were some difficulties—for example, in terms of the use of indexation that they use. It was not what was commonly used. It was difficult to understand what population growth numbers they were using. They did incorporate that issue around that PBS that I referenced previously. They did take account of that so that it wouldn’t distort figures with previous periods and forward periods. So they flattened that. We do have the expert in that area. When we tried to run a similar sort of approach in that area, we came to slightly different conclusions to them. We have nominal growth of around 3.8 per cent for the whole of government.

Dr Hartland : Mr Wann is right. We did our own analysis of per capita expenditure by taking population from the ABS, whole of government health expenditure and using CPI as a deflator. We came to a different result to Macquarie University when we did that.

Senator WATT: Right. So what do you say the increase it?

Dr Hartland : When you look at per capita health and aged-care expenditure, and you deflate it with CPI, we are seeing real growth over the forward estimates.

Senator WATT: What is the age?

Dr Hartland : It is just under half a per cent per annum.

Senator WATT: Just under half a per cent per annum real growth across each of the years in the forward estimates?

Dr Hartland : On average.

Senator WATT: Okay.

Mr Wann : That is taken into in population.

Dr Hartland : That is right. That is per capita deflated by CPI.

Senator WATT: So that is not the same as real growth, which in terms of expenditure is just flat?

Mr Wann : That is right.

Senator WATT: And what are the figure if we ask for that?

Mr Wann : I think it is in the order of 1.3 per cent real growth, but per capita brings it down a little bit further.

Dr Hartland : If you just look at growth without per capita and you CPI, you get an average increase of about 1.4 per cent per year.

Senator WATT: You would have seen in that article that the centre’s director, Dr Henry Cutler, said that real health expenditure would grow 1 per cent less than the population over the forward estimates, which would mean less money on a per capita basis. Is that accurate?

Dr Hartland : That is not the result we found. These calculations are quite sensitive to all of the three parameters, obviously—so funding data, the population series and the price deflator. We used the ABS series C for population, which we think is the most accurate. If you use other series you can get a different result. And we have used CPI rather than a health price deflator because, as far as we are aware, there is no forecast of health price deflators, so they are a bit unwieldy to use to look at the forward estimate periods. When we use those parameters, we find real growth.

Senator WATT: So you think that that analysis by the Centre for the Health Economy is wrong?

Dr Hartland : We can't verify the parameters he has used.

Ms Beauchamp : The Treasurer has actually set out in Budget Paper No.1 and does mention expenses into the health function, which covers the broad remit of the services I spoke about earlier. It does talk about an increase of 0.4 per cent in real terms from 2018-19 to 2020-21. So we would go with what the Treasurer has identified in here.

Senator WATT: I am asking you as the secretary of the department, though, what you think the answer is?

Ms Beauchamp : The secretary of the department and the department does get involved in whole-of-government issues and we are a contributor to support the government in preparing the budget papers. So we stand by the budget papers.

Senator WATT: Okay. So you are confident that health spending is keeping up with inflation and population?

Ms Beauchamp : That is what the figures show us, yes.

Senator WATT: In that article, Dr Cutler—and he is obviously a pre-eminent health economist—says that service gaps are getting worse and that, if the current trends continue, Australians will either face worse health outcomes or be asked to pay more for their healthcare if the government does not respond. Do you agree with his comments, Ms Beauchamp?

Ms Beauchamp : I think going forward we need to look at the sustainability of the health system and how that is financed overall. I think we will be faced with challenges in the future whilst we have a significant proportion of the budget allocated to health. I’m not in a position to say whether that is right or wrong. It would be hypothesising in terms of what is going to happen in the future.

Senator WATT: One way of dealing with the sustainability of the system is that Australians are asked to pay more for their healthcare.

Ms Beauchamp : There are a number of ways to deal with the sustainability of the health system in terms of financing overall. We have a very good balance between public and private.

Senator WATT: That is nicely avoiding the questions. Are there any proposals currently under consideration that would result in Australians paying more for health services?

Ms Beauchamp : There are currently no proposals under consideration for individuals to pay more.

Senator WATT: For individuals to pay more? I want to get the language right. You are not working on any new proposals that would result in Australians paying more for their healthcare?

Ms Beauchamp : We are not working on any new proposals at the moment, no.

Senator WATT: That is it for this bracket. Senator Singh has some questions and we have some others. I am not sure how you want to divvy up the time.

CHAIR: Senator Di Natale, do you want to take over for a bit?

Senator DI NATALE: Thank you. This might be one for you, Professor Murphy. I suspect you are aware of what is coming, and well done on your performance last night on Four Corners. They were very measured responses.

This is obviously in reference to the recent reporting on out of pocket costs. I want to go to the question of fee transparency. I want to point you to a couple of Senate reports, one of which was a Senate report into out of pocket costs from 2014. Another was in relation to out of pocket costs in 2017. I am intimately familiar with both of those because the 2014 was my referral and I participated in both of those Senate inquiries. The recommendations that came through in both Senate reports was that there needs to be more transparency in the system. As I said, this dates back to 2014. Can you tell me what progress has been made in that area?

Prof. Murphy : I would have to say that the ministerial advisory committee that I am chairing is making very good progress in that space. We have unanimity amongst all the leaders in the medical profession—the AMA, colleges and special societies—that we need a transparency solution that achieves a number of things. One option is that we work out a mechanism to prohibit hidden booking or administrative fees. So no fees should be charged to any patient other than those linked to a clinical service—a Medicare item—and disclosed to Medicare and the private insurer. Patients should be provided with information regarding the costs of their procedure or encounter prior to the first clinical encounter.

One of the challenges we have at the moment is that, if people are provided with financial information once they have had the first consultation, they are locked into a situation where they can't extricate themselves when they find that the fees are not what they expected. So we are working very hard and very collaboratively on a solution. In an ideal world, a general practitioner might be able to refer someone to three or four respected medical specialists and that patient could get access to information about the real impact of out-of-pocket costs and fees before they make a choice of specialist. It is complicated to provide fee information before the first clinical encounter because of the complexity of our private health insurance scheme and the impact of safety nets and the like. We have to make sure that the information provided to consumers will be provided in a form that is understandable and meaningful so that it can help guide choice.

On top of that, the committee is very keen for us to conduct a public relations campaign to inform the community that there is no relationship between price and quality. So, when somebody charges a higher fee, there is no evidence that they provide a higher quality of service. The committee is actively working with every single special medical society at the moment to work on this transparency solution. We intend to work out a way of making that something that every medical specialist would subscribe to. We are due to report back to the minister by the end of the year. I'm hoping we might even finish the work earlier than that. We have a very important meeting of the committee coming up in late June where we will be looking at some serious options for how we provide this transparency solution.

Senator DI NATALE: You mentioned booking fees. I think the President of the Royal Australasian College of Surgeons stated that booking fees were illegal.

Prof. Murphy : They are not illegal under Commonwealth law but they are in breach of the contract that the medical specialist has with the health insurer. Some of those contracts are not very enforceable. But, essentially, when a private insurer agrees with a surgeon or another specialist to have a no gap or known gap arrangement, that specialist agrees to charge no more than a certain fee. On the basis of that, the insurer pays a much higher benefit, sometimes 165 per cent of Medicare, so that the patient has either no gap or only a $500 gap. What these specialists have been doing is charging that agreed maximum fee openly but then charging the patient a booking fee which isn't disclosed to the insurer. So that is breaching their agreement with the private health insurers.

Senator DI NATALE: I know some of my colleagues bemoan this practice. If the practice is in breach of the contract that the surgeon has with private health insurers, what action is being taken to prevent it from happening? It has been going on for years.

Prof. Murphy : The insurers have found it quite difficult because often the consumer won't inform the insurer that it has happened.

Senator DI NATALE: But insurers have known about this for many years.

Prof. Murphy : They have, indeed, and they are very keen to close this gap. As I said, we are hopeful that we will end up with a solution where every medical specialist will commit—

Senator DI NATALE: Hope is one thing. I'm just getting to the issue of what the mechanism is to stop surgeons charging. It is unethical, if it is not an illegal practice. For laypeople, you have the cost of this surgery and then the surgeon will just charge a fee plucked out of god knows where—in addition to the services that they have provided to the patient—that is not covered by Medicare or by the private health insurer.

Prof. Murphy : I agree, Senator. We will end up with a solution that will stop this practice by the end of the year. I can't tell you exactly what that solution will be. It may well be a public commitment, enforceable under consumer law, that the specialist won't be able to charge a fee other than those that are disclosed to Medicare. I don't want to pre-empt the work of my committee, which is looking at a variety of ways of achieving that. The cooperation I have had from the medical leaders has been fantastic and I want to work through with them what will work before we make a public announcement. The minister has been very clear to me that he wants this practice stopped.

Senator DI NATALE: The inquiry back in 2014 recognised this as an issue. It has been going on for many years and it is an open point of debate within the medical community. We have seen a lot of people downgrade their private health insurance cover as a result of being stung with out-of-pocket costs. It has taken a long time to respond. When was the medical advisory committee established?

Prof. Murphy : We were set up late last year. It came out of the private health insurance reform. I can't remember the exact date, but it was last year. We get together 12 leaders of the medical profession. We have got them together on three occasions so far and we are actually engaged in working on this transparency solution. As I said, I think we will be able to report before the end of this year. It was formed in the second half of last year.

Senator DI NATALE: You said it was a contract, effectively, between the surgeon and the health insurance provider. It is obviously not in the health insurance industry's interest to have this practice continue. Why haven't they taken action?

Prof. Murphy : It's because, in many cases, paradoxically, if the consumer declared that this was happening, the insurer would pay them less because they would only pay them 100 per cent of the Medicare fee. That is because the extra payment is conditional on the surgeon not charging more than the agreed amount. So it is an unusual situation where—

Senator DI NATALE: But then that is a breach of the contract between the surgeon and the health insurance provider.

Prof. Murphy : It is a breach of the contract.

Senator DI NATALE: Why aren't they taking that to—

Prof. Murphy : It's because they have trouble finding out where these breaches have occurred. By very definition, this practice is hidden.

Senator DI NATALE: I am surprised to hear that. I would be interested to look to the ombudsman on this. I would have thought it is one of the major issues in out-of-pocket costs because it is just a fee that is charged at the discretion of the surgeon.

Prof. Murphy : It is an issue. But the insurers have tried to get this information. We are actually engaging in a survey with private health insurers to properly survey a subset of consumers at the moment, just to find out the extent of it. In general, insurers find that the consumers don't report this practice to them. So they have trouble finding out about instances where this has happened. Some of them know that it is happening but they don't know the extent of it. We live in a world of anecdotes in this space, unfortunately.

Senator DI NATALE: I won't labour that point too much. I want to go a bit more to this transparency piece as the centrepiece of the response from the advisory committee. One of the concerns is that if you disclose the fees of all surgeons or service providers—it is not just surgeons—you might create a perverse incentive for people who are charging lower fees to actually raise their fees. Is that something that is being considered? Is that a concern?

Prof. Murphy : It has been raised as a potential issue. At the moment we know that there is pretty good visibility from specialists, especially about what is being charged in their city. I know that, for example, fees among certain speciality groups are higher in some cities than the others. That information is generally known amongst specialists. It is also true that, if consumers are aware that there is no relationship between price and quality, they shop around. We are already seeing instances in some states where people are reducing their fees because they are getting less work. That is a potential issue.

Many of the specialists do have their historical fees included as information in a transparency solution. That would also protect against changing their fees from that point onwards. It is something that that committee has raised as a concern. That is why we are very keen to get that message out there to the public—because one of the biggest challenges, perversely, is this very small proportion of specialists who are charging egregious fees. They are marketing themselves as, 'I am so good; that is why I am so expensive.' So we have to get the message out to the community that we have very good, well-qualified specialists in Australia, most of whom charge only modest and proportionate fees, and that they should avoid those people who claim to provide a better quality service for a substantially higher fee.

Senator DI NATALE: I want to unpack that a bit further. It seems that the focus of the reform is to provide patients with more information, which I think we would all agree would be helpful to some degree. But are you relying on that as the mechanism that will ultimately drive down prices? To me, it seem unlikely that it is going to have the impact that, obviously, the committee hopes for. That is for a few reasons. One is that it is the GP that ultimately refers people on. If you are asking patients to make a decision about their choice of surgeon, my experience, and I think the experience of most GPs, is that patients will say to their GPs, 'Tell me who you think I need to see.' To actually put this in the hands of patients and say, 'You can decide who you want to see,' seems to me unworkable in practice.

Prof. Murphy : No, that is not what I said. What I said was about the model, and many GPs are supporting this model. We absolutely respect the need for the GP to be involved in their choice of specialist, but what we are envisaging is that most GPs would know four or five specialists in a certain area who they believe provide high-quality care. The GP would say to the consumer, 'Here are four or five particular surgeons or proceduralists who can do the thing that I think you need.' In some cases the GP will be happy to help look at the transparency information and find the fee information. Sometimes they will leave it up to the patient. The GP will still provide the gatekeeper function. But in that gatekeeper function they will provide a range of people, such that the patient can use fee information on top of the GP's selection.

Senator DI NATALE: Shouldn't the target of your campaign be GPs then?

Prof. Murphy : We are very much engaging the GPs. The GPs are involved in the discussions and they will be very much part of the solution we provide. Some of the GPs say they don't want to be involved in the fee process. They are happy to make referrals to people on the basis of quality of care. Other GPs say they very much want to be involved and they want the solution that we provide to be able to give them the information so that they can help with the patient's choice. So GPs are definitely involved.

Senator DI NATALE: I suppose my concern—and it was also borne out in the 2014 inquiry into out-of-pocket costs—is that patients are very reluctant to take on a surgeon over cost because they fear it is going to jeopardise their treatment. It might delay their treatment. To put the responsibility on patients is potentially avoiding the bigger problem.

Prof. Murphy : What we are saying is that the patient can have that information before they exercise their choice from the range of specialists that the GP has recommended so they are not in that difficult situation. I agree. Once you have undertaken a clinical encounter and you have a relationship or proceduralist, it is very hard for you to back out. But if you get that information before you have any relationship then you can make a decision based on fees without it interfering with that relationship or that care because you haven't got a relationship.

Senator DI NATALE: I suppose that goes to the problem where you might have these outliers, these surgeons, who are charging ridiculous fees. They know that they can get away with it. They charge booking fees. We know that it is a very small proportion, but it is obviously a very serious problem. So transparency before the initial consult might, in some instances, particularly if the GP is aware of it, actually do something about that problem. But the big problem that we, again, heard about in both inquiries is what they described last night as 'cumulative bill shock'. That is effectively saying that you can't know the out-of-pocket costs associated with a procedure, particularly if it is a more complex diagnosis that requires ongoing treatment—chronic disease and so on. It is one thing to have an arthroscope in a private hospital. It is another thing if you have a diagnosis of cancer. Breast cancer was the example used last night. It was also the example used in the Senate inquiry. You don't know that there will be a number of procedures—there are pre-op procedures, post-op consults, pathology, imaging and, obviously, an anaesthetic fee. There are a range of ongoing costs associated with a diagnosis and treatment that can't be known, and they all add up. What you have described in terms of knowing the surgeon's fee prior to the consult is not going to deal with that. And that is the bigger problem, isn't it?

Prof. Murphy : Well, no. I think the information that the surgeon will provide will include information about the anaesthetist, the fees that the anaesthetist charges and other associated medical costs with that particular episode. What you are talking about with cancer is quite complicated because cancer treatment is a series of episodes of treatment. So, with breast cancer, you may have primary surgery, you may have chemotherapy, you may have radiotherapy and you may have reconstructive surgery. You are absolutely right. One of the challenges that the committee is working on is that often people, once they start with their first specialist, then get referred on in a chain without the patient having a chance to competitively look at the situation. A good example is radiotherapy. Many people will choose to have primary surgery in the private sector but they may not be made aware of the fact that 60 per cent of radiotherapy is available in the public sector and has no out-of-pocket costs. So those people are not always given a choice.

So, again, the committee is working on having a transparency solution at each stage of that journey. Patients may choose to have private surgery. If they then find the costs of radiotherapy and private chemotherapy unacceptable, there is good access to public services for those things. It is a matter of getting as much information to the consumers as we can and giving them choice at each stage of the journey. We accept that cancer is the most complicated issue because of that multiplicity of services. Some of those outpatient services, the non-admitted services, are covered by the safety net, and there is relief in that. But those complex, multi-admission services are more difficult. What we are focusing on initially are those really egregious ones—for example, the $20,000 prostatectomy, which you heard about last night.

Senator DI NATALE: In terms of some of the other responses, apart from transparency, have you considered any restrictions on providers or is the committee considering any restrictions on providers who charge above a particular range? If not, why not?

Prof. Murphy : Not at this stage. That would be very difficult, constitutionally and legally. But it is possible to consider that. I think the minister's view at the moment is that we should focus very much on improved transparency. We are pleased with the response of the medical profession's leadership to try to address this both internally and through whatever solutions we have. We would prefer to see what happens with a transparency solution before trying to get into the difficult and complex regulatory system of fee regulation, because there are all sorts of definitional issues and constitutional issues that you would have to consider. Those things are possible for the future if this sort of transparency approach doesn't achieve the desired outcomes. I am confident that it will have an impact.

Senator DI NATALE: I suspect it will have an impact on some of those rogue providers. It is not going to do anything about people who have ongoing episodes of care and are faced with a number of out-of-pocket costs which cumulatively will potentially result in tens of thousands of dollars in out-of-pocket costs.

Prof. Murphy : It may if those ongoing episodes of care are subject to the same transparency and contestability, because there are many specialists for people who have limited financial circumstances. They will charge no gap at all, bulk-bill or just charge a very small gap so that they are provided with the choice—

Senator DI NATALE: Who makes that decision?

Prof. Murphy : It is currently the decision of the medical specialist. They make that decision.

Senator DI NATALE: So you are relying on individuals to make a decision—

Prof. Murphy : Yes. Plus, the fact is there is now, certainly in the major cities, an ample supply of most specialists. One of the areas where significant out-of-pocket costs have been a problem is obstetrics. We are already seeing now a significant reduction in fees in some capital cities because of increased competition now that patients are starting to become aware of the fact that price and quality aren't related. So we think competitive pressure will come into play.

Senator DI NATALE: You outlined the example in the cancer treatment space where radiotherapy was an option within the public system. Surely the easiest way to avoid these out-of-pocket costs is to have treatment within the public system? You argument effectively is, 'Well, if people are worried about it, they can go to the public system.'

Prof. Murphy : No, I'm just saying that that is the choice. Everyone has the choice at each stage. Many people would choose to have their surgery done in the private sector because they may get their surgeon of choice and they may feel that that is more important. Some of them may prefer to have private radiotherapy. But radiotherapy is not an admitted procedure and there is good access to public radiotherapy at the moment. So they may choose that. But they may still choose the private sector. What we are keen to do is to make sure that everybody has the full range of information available so that they can choose and so that they are not on a path that is predetermined, from private surgery to private radiotherapy, if they don't have the means to do that.

Senator DI NATALE: But, again, surgeons will make decisions or very strong recommendations to patients based on what they believe is in the patient's interest. You are putting a responsibility back on the patient to say, 'No, you need to push pack against the surgeon.' We know from all of the evidence we have heard from previous committees—indeed, it was also presented last night—that it is very difficult for patients to push back that worry about what it is going to do in terms of compromising the care that they receive. If the central focus of the reforms is to say that now we are going to leave it to patients—

Prof. Murphy : I think informing patients before they are locked into that situation is really clear. What we would say is that the GP should refer them to four surgeons. They can choose the surgeon. When it comes to radiotherapy, the surgeons would be in a position of saying, 'Here is the private radiotherapy provider I use, but there is a public provider,' and provide that information to patients beforehand so that the culture is that patients are given a choice at each stage. That is what the medical leadership is committed to at the moment.

Senator DI NATALE: Well, it's not happening within the profession.

Prof. Murphy : It is not happening at the moment, but the leadership has to bring about that cultural change across the medical profession. They are committed to doing so. As a medical practitioner you would know the fact that when patients are put in severe financial hardship it—

Senator DI NATALE: For many years.

Prof. Murphy : is very disturbing to many medical practitioners. It is completely unethical in their concept. So the leadership of the medical profession, including the private practice based specialist societies, are very committed to try to make this change.

Senator DI NATALE: Going back to the example of radiotherapy, isn't the problem that we have effectively established a system through the private health insurance industry where we have a set of incentives through the private health insurance rebate and a set of punishments, if you like, through the Medicare levy surcharge that are directing people into private health with the stated intention—as it was stated publicly at the time—of taking pressure off of the public system? Instead of public health care being universal and not being a cost to the consumer, isn't the way we are taking pressure off of the public system just forcing patients to pay more?

Prof. Murphy : Radiotherapy does not have private insurance. It is not an admitted service.

Senator DI NATALE: I am talking generally, though.

Prof. Murphy : Yes. We have a very strong national commitment to a private-public system where people have choice. The consumers, the community, are very much in favour of that mixed private-public system. So that is what we are working within.

Senator DI NATALE: Do you think that the decline, particularly the number of people downgrading the level of their private cover, is a direct consequence of the increasing out-of-pocket costs that people are facing?

Prof. Murphy : It is claimed to be a factor in the surveys of private health consumers, yes. It is one of the factors that they talk about. The most prominent reason is the actual size of the premiums, but the out-of-pocket costs are stated as a factor for people who choose to drop private insurance.

Senator SINGH: I want to go to some of these structural changes to the flexible funds. I particularly want to ask you a little bit about a reply received from the department to a question on notice from Senator Watt after last estimates. I can give you the number of the particular question. It is SQ17-1443. The question was about providing the total amount allocated to each flexible fund each year from 2013-14 up to 2020-21. In the department's reply, you state:

Health currently manages its administered appropriation under 'priority areas', rather than the previous structure, which included the former flexible funds. From 1 July 2016, the former flexible funds were redistributed into a new outcome and program structure.

Firstly, who led the change in structure? Was it the department itself that led this change?

Ms Beauchamp : If I understand your question correctly—and it is probably my ignorance in terms of not being in the department in 2014—our expenditure, revenue and budget is governed by what is in the portfolio budget statements under each of the six outcomes. So the six outcomes are a given, and the subprograms are part of that. The government funds programs and initiatives under each of those subprograms in terms of what is in the portfolio budget statements.

Senator SINGH: I acknowledge that you weren't secretary of the department in 2014, but there must be somebody here who can say who led the change in the structure. Was it the department?

Ms Beauchamp : The change in structure would have been determined with the Department of Finance in terms of coming up with an outcome structure that provided more accountability and transparency for parliament in the use of funds across the portfolio.

Senator SINGH: What is your total administered appropriation in 2018-19 and each year across the forward estimates? If it is in the portfolio budget statement you can tell me the page. That would be great.

Ms Beauchamp : I am looking at page 28 and 29 of our portfolio budget statement, which does outline total administered funding and resourcing for the department. On page 29 it talks about total resourcing for 2017-18 and 2018-19 in terms of administered funding.

Senator SINGH: For Hansard, can you actually say what that is?

Ms Beauchamp : For 2018-19?

Senator SINGH: Yes.

Ms Beauchamp : It is $68,261,432,000.

Senator SINGH: What about the forwards?

Mr Wann : I actually don't have those figures. I have whole of government. So they are the appropriations for the department. What we do have is the whole-of-government split, which takes into account all of the funding under administered programs going to health, aged care and sport. It would include DVA, DSS, DHS and the portfolio agencies. I can provide you with that number. I would have to take the appropriation to the department on notice.

Ms Beauchamp : We can give you the whole-of-government figure.

Senator SINGH: I am actually asking at the moment about the flexible funds. But go ahead with what you do have.

Mr Wann : In terms of health, aged care and sport, the total allocation in terms of administered funding in 2018-19 is $99,055,000,000. For 2019-20 it is $101,888,000,000. For 2020-21 it is $104,565,000. For 2021-22 it is $108,976,000.

Senator SINGH: Where in this portfolio budget statement are these new priority areas outlined that you have subsumed the flexible funds into, because I cannot find them?

Mr Wann : At this level it goes to sub-outcome level and then under the sub-outcomes are the priorities. If we go to outcome 1, for example—

Senator SINGH: What I am trying to find here is where each of the flexible funds are now hidden. In your response to Senator Watt at last estimates, you said, 'Health currently manages its administered appropriation under "priority areas".' You put that in inverted commas. So there is some kind of change of structure. You talked about the 'previous structure, which included the former flexible funds'. Now we have this new structure. I am trying to understand this new structure and where I can find the flexible funds in these new priority areas.

Mr Wann : If you go to the examples on page 59 and look at outcome 2, that is probably relevant in this context. You will see the various programs listed under outcome 2. So program 2.1, mental health; program 2.2, Aboriginal and Torres Strait Islander health, and so on. Within that, we then have priorities. That splits those programs into lower levels of reporting.

Senator SINGH: How many priority areas are there and what are all of these priority areas?

Mr Wann : There are 200 priority areas.

Senator SINGH: Right. Can we get some kind of list of what they all are?

Mr Wann : Yes, absolutely.

Senator SINGH: Do you have to take that on notice or can that be tabled to the committee?

Mr Wann : We will take it on notice, but we can get it to you very quickly.

Ms Beauchamp : But it is set out in the budget papers.

Senator SINGH: Can you show me where?

Ms Beauchamp : I think Mr Wann spoke about page 59 and the programs in each of outcome 2.

Senator SINGH: But which are the priority areas?

Ms Beauchamp : All of the priority areas are listed here under—

Senator SINGH: There are seven priority areas there; is that what you are saying—from 2.1 to 2.7? Are they priority areas?

Ms Beauchamp : No, under each of those program areas there are subprograms, which represent the priority areas.

Senator SINGH: Right. And where are those subprograms?

Mr Wann : They are at a lower level of reporting that is not reported in—

Senator SINGH: So they are not in the portfolio budget statement?

Mr Wann : No, but we can get you a list of them.

Senator SINGH: Why aren't they in the portfolio budget statement?

Mr Wann : Because the standards for the portfolio budget statement don't require that sort of reporting.

Senator SINGH: So the flexible funds are no longer identified in the budget. Is that what you are saying?

Mr Wann : They are grouped into those—

Senator SINGH: They are grouped into those priority areas which are not in the budget statement.

Mr Wann : You are absolutely correct. It doesn't go down to that level of detail.

Senator SINGH: Isn't that an issue of transparency? You have created this new structure. The flexible funds are no longer kind of flexible funds. They are not being subsumed into these priority areas. You have told me there are 200 priority areas, none of which are listed in the portfolio budget statement—and which we still don't have a list of. You have had to take that on notice. It seems to me that the flexible funds have been completely hidden by this government.

Mr Wann : When it comes to the relevant outcome, you are in a position to ask questions about the detail under each of those programs and how those are mapped across. We are able to provide you with a list of those priority areas. We can do that quite quickly. Not instantaneously, but certainly later today we can get you that list.

Senator SINGH: Well, they are hardly priority areas if you don't have a list of your priority areas available to us right now. Anyway, let's go on. We are going to have to dig down a bit into this, and I am hoping it won't all have to be taken on notice. How much funding of each of these priority areas is committed?

Mr Wann : We would be able to provide that. There is reporting underneath priority areas and you can go all the way down to cost centre level. It is, I guess, the way that is most appropriate in terms of a management and in a performance reporting sense. And the portfolio budget statement certainly stipulates that this is the level that is appropriate to report at.

Senator SINGH: Okay, but these priority areas, you are saying, have funding committed to them and yet they are not in the budget statement.

Ms Beauchamp : Just as an example, one of the funding items was 'practice incentives for general practice'. That certainly is identified clearly as a separate line item under program 2.6, with an allocation of funding provided there over the forward estimates. And it is clear to see on page 64, for example, around primary care practice incentives, where we have primary health care quality and coordination. This budget articulates, perhaps, a different way of presenting the information. I don't think—

Senator SINGH: It certainly does.

Ms Beauchamp : it is around a lack of transparency. It is absolutely transparent. Perhaps it might be easier to map exactly these funding items that would have been seen under the flexible fund into where they appear in the budget papers. I just gave you an example of one of them, which was the practice incentives for general practice, which is clearly highlighted on page 64.

Senator SINGH: It is not highlighted as a priority area. How do I know that that is one of the 200 priority areas? It doesn't say it.

Ms Beauchamp : Sorry, it is highlighted as a separate line item in the budget papers.

Senator SINGH: It doesn't say it is a priority area.

Mr Wann : No.

Senator SINGH: The question by Senator Watt at the last senate estimates was in relation to the flexible funds and where forward spending was on those from 2013-14 to 2020-21. Your response was that they have now been administered under 'priority areas'. I am now asking you where those priority areas are, because I can't find them in the budget papers and neither can you. And you are telling me that it is transparent. It is not transparent, Ms Beauchamp, because it is not there.

Ms Beauchamp : Sorry, these are the priority areas. One of them I just highlighted.

Senator SINGH: How is anyone else supposed to know that? You know that.

Ms Beauchamp : Just to pick up another one, in terms of Indigenous health funding, the Indigenous Australians' Health Program is absolutely identified as a priority area.

Senator SINGH: Could you show me where? Where does it say that it is a priority area?

Ms Beauchamp : As I said, I will map those flexible funds to exactly where they appear in the budget papers for you.

Senator SINGH: Okay, I would appreciate that.

Senator WATT: There are no consolidated budget papers, though.

Mr Wann : No, not in that one.

Senator SINGH: On those flexible funds.

CHAIR: Can I just ask a question to clarify? My understanding from past history is that Finance set the parameters for what needs to be in the portfolio budget statement.

Mr Wann : That is exactly right, and this is the level and the structure that has been agreed to and approved by Finance. There are rules, obviously, around what you can do with money once it is in the program structure, and limitations on moving money between programs and certainly between outcomes. The lower you get, the greater flexibility there is to move money around within those programs. So it improves in terms of resource allocation and ensures that we have resources where they are required. But at this portfolio budget statement level, there are some hard barriers that you have to adhere to. You have to seek approval either through government or the Minister of Finance or advise Finance if you are going to make changes to the reporting that is made at the portfolio budget statement level.

Senator SINGH: Ms Beauchamp, how much of the funding is allocated in each of these 200 priority areas each year of the forward estimates?

Mr Wann : Most of them will be in bill No. 1, but we can take that on notice and get back to you with an answer.

Ms Beauchamp : Probably the best way to do it is to give you the forward estimates for each of the subprograms, which are the priority areas—that is, mental health, Aboriginal and Torres Strait Islander health, health workforce and those sorts of priority areas.

Senator SINGH: We would like the whole 200 on notice, if you are going to do this. Thanks. Also, how much is contracted and committed and how much is uncommitted?

Ms Beauchamp : That is a completely new question.

Senator SINGH: Yes.

Ms Beauchamp : The subprograms, if I can just confirm, are absolutely outlined in the portfolio budget statements and there is funding for 2017-18—estimated, actual and each of the forward estimates. For example—

Senator SINGH: Excuse me, Ms Beauchamp, are you saying that the subprograms are the same as the priority areas?

Ms Beauchamp : I think that the subprograms are probably the best way to look at it in terms of priority areas.

Senator SINGH: I am asking you: are the subprograms the same as the 200 priority areas?

Ms Beauchamp : Not exactly, no. There is a further level of detail beneath those subprograms. I am trying to make it easier so you can map it exactly to the budget papers. So, yes, we will get that information for you. You have asked for committed and contracted funding. When you have the number of program areas we have, and I think over 9,800 different contract areas, then it is a big job to look at committed and contracted funds. Of course, those contracted funding amounts change over time as contracts are entered into and renewed and the like. So I will absolutely have to take that on notice.

Mr Wann : They would change almost on a daily basis—the level of commitments and pre-commitments.

Senator WATT: Let's just go with, as of today. If you could take that on notice.

Ms Beauchamp : As of today. We will get you the committed and contracted under each of the subprograms.

Senator WATT: We would also like it broken down into the 200 priority areas. We want to get into that level of detail.

Ms Beauchamp : I just want to make sure that we can manage that. It is a hugely busy portfolio. I will look at what information is available, confirm the number of subprograms and the level of detail and provide what is committed and contracted for each of those, without getting in the way of delivering on all of the budget initiatives that we have in front of us.

Mr Wann : To take a point in time would require quite a large exercise. We couldn't provide something of that detail today. But we will see what is involved and get back to you.

Senator SINGH: Do you think it is acceptable, Ms Beauchamp, that you can't tell the parliament where your administered appropriations are going?

Ms Beauchamp : I think it is very clearly set out in our portfolio budget statement. When I spoke about $99 billion per annum by subprogram, that is identified in each of those areas. The flexible funds, which I think you have been referring to, are a very minor proportion of that $99 billion per annum. I think you are talking about $2 billion worth of funding under the flexible fund.

Senator SINGH: So you think that $2 billion is minor?

Ms Beauchamp : I think it is a small proportion of the $99 billion per annum. The government has clearly set out where our administered funding and our departmental funding goes. I just want to make sure that we can provide that level of detail that you are looking for. The problem is that we have, I think, over 760 individual programs across the whole portfolio. When you are looking at the number of contracts and committed within that, it is a very large piece of work to do.

Senator SINGH: Well, let's try to get back to the detail of the flexible fund. You would recall then that in the 2014 budget, the 2015 budget and the2016 budget there was a combined cut of $975.5 million to the former flexible funds. $104.2 million of those savings were budgeted in 2015-16 when the former flexible funds were still in place. Were those savings achieved?

Ms Beauchamp : I would have to take that on notice.

Senator SINGH: Okay. Can you also then give us a breakdown of which flexible funds, as they stood then, those savings came from?

Mr Wann : Those savings would have been achieved as a matter of course, in terms of the money was taken out of the appropriation. Are you asking in what way that was given effect?

Senator SINGH: Yes. To the flexible funds.

Mr Wann : The flexible funds don't exist.

Senator SINGH: As they stood at that time when they did exist.

Mr Wann : Back in 2015-16?

Senator SINGH: Yes.

Mr Wann : Okay. We will definitely have to take that on notice.

Senator SINGH: The remaining $870.9 million of cuts were budgeted for 2016-17 to 2019-20. That is, after the new priority areas were put in place. Can you confirm that these savings will be achieved from the new priority areas?

Mr Wann : Again, in one sense they have already been achieved because they have been taken out of the appropriation. In terms of the nature of the programs and the way that has been given effect, that would vary from program to program. With the priority structure and the programs, the way they are shaped underneath that, that would be almost an outcome by outcome proposition. Generally, the first two outcomes would be where a lot of them would be. The program owners would have to work through how that was given effect.

CHAIR: Can I just jump in there, Senator Singh? Minister, can I just confirm that the government's policy remains that any savings made in the health portfolio are re-invested in the health portfolio?

Senator McKenzie: Absolutely.

CHAIR: Thank you.

Senator SINGH: If you could give us a breakdown of the cuts by year and priority area on notice, that would be appreciated.

Mr Wann : Noting that those cuts have already been made and used as offsets, I guess, against other spends. So those cuts have already been taken out of the forward estimates. So, again, I guess the question is that you want to know if that has been give effect. The cuts have already happened and it is giving effect to that.

Ms Beauchamp : The difficulty will be that there has been, I think, three budgets since then. There would be ons and offs within each of our subprograms that I talked about. So it would be very hard to map what has happened other than, as Mr Wann says, the budget savings would have been taken some time ago. But there have been a number of initiatives, and three budgets worth of initiatives, that have impacted on each of those programs and subprograms.

Senator SINGH: The question was if you could take on notice the cuts by priority area.

Ms Beauchamp : Sorry, when you say, 'by priority area', do you mean for flexible funds allocated in 2015-16 or the current priority areas?

Senator SINGH: No, that was not the question. That was the previous question. My question just now was in relation to the 2016-17 to 2019-20 budget cuts. That is the remaining $870.9 million. I asked if you could confirm whether these savings will be achieved from the new priority areas and a breakdown of that amount—that cut—by year and by priority area.

Mr Wann : Again, I will just say, though, that the cuts have already been achieved. They have been taken out of the appropriation.

Senator SINGH: In 2015-16?

Mr Wann : In 2015-16.

Senator SINGH: I thought the remaining $870.9 million was budgeted for 2016-17 to 2019-20. Has that already been cut?

Mr Wann : Yes, back with the original decision.

Senator SINGH: Okay.

CHAIR: Are you going to change topic here, Senator Singh?

Senator SINGH: No, it is still flexible funds.

CHAIR: I will throw the call elsewhere if—

Senator SINGH: No, it is still the same topic.

CHAIR: Okay.

Senator SINGH: I want to ask about flexible funds in relation to services in north-west Tasmania and whether those services were quarantined from cuts to the flexible funds. That includes the $197.1 million cut in 2014-15, the $962.8 in the 2015-16 budget—which included cuts to, obviously, the flexible fund—and the $182.2 million cut in the 2016-17 budget. Was there any quarantining of services in north-west Tasmania?

Mr Wann : I think we would have to take that on notice.

Senator SINGH: I am particularly interested in the government's cuts to the TAZREACH program. You would be aware that the TAZREACH program is a vital program in north-west Tasmania and can be the difference between someone getting the care they need or missing out altogether. The cuts to this program are really important to the north-west of Tasmania. I would like to know whether those cuts to TAZREACH were the result of the 2015 budget decision. Do you have to take that on notice as well?

Mr Wann : Yes, I think we do.

Ms Beauchamp : I have just asked to see if I can get the officers here that are responsible for that program.

Senator SINGH: Okay, great. My question is in relation to the TAZREACH program and whether the cuts to that program were a result of the 2015 budget decision?

CHAIR: Sorry, just before you answer, Mr Hallinan, we are happy to be flexible in the cross-portfolio section, but if we start getting into really specific program details for other areas—

Senator SINGH: It is still budget cuts.

CHAIR: Okay.

Mr Hallinan : The TAZREACH program was rolled out as an element of the then medical specialist outreach assistance program. That was an outreach program across the country. It was established through a 2012 commitment by the then government but was scheduled to terminate in June 2016, which is when it terminated.

Senator SINGH: Were the cuts were a result of the 2015 budget decision?

Mr Hallinan : No. My understanding of that program was that it was scheduled to terminate, as a terminating measure, in June 2016, which is why the funding for it discontinued at that stage. But that does go back a couple of years now, so I can take the details on notice and confirm that for you, if you like.

Senator SINGH: Okay. It was reported in June 2016 that the funding to TAZREACH was reduced by $2.5 million by the West Coast Council mayor. Are you aware of that?

Mr Hallinan : It would be in that order, yes.

Senator SINGH: It would be in the order of $2.5 million?

Mr Hallinan : The additional funding that was committed in the period between 2012 and 2016 was $1,021,000 in 2013-14, $1,564,000 in 2014-15 and $2,392,000 in 2015-16. That additional funding ceased in June 2016 in accordance, I think, with the original measure from 2012. But I will take that on notice and confirm it following the hearing. There is still funding going into outreach activities in Tasmania through the rural health outreach fund. I think it is in the order of $1 million to $2 million per annum. Again, I can take that on notice.

Senator SINGH: Okay. What did this reduction mean for outreach services on the north-west coast of Tasmania?

Mr Hallinan : I would have to take that on notice. It did cease almost two years ago now, so it is not something that I have detailed information on with me.

Senator SINGH: Okay. I just refer to the West Coast Council mayor, Phil Vickers, who said,

The loss of these services places more stress on unwell residents and will also place more pressure on these services in other regions as West Coasters will now have to travel to attend appointments.

So it was clearly reported by the mayor that the reduction in funding of this program has had an impact in the region. Are you saying that you are not aware of that?

Mr Hallinan : It certainly would have led to a reduction of outreach services in that region.

Senator SINGH: You are confirming that? Okay.

Mr Hallinan : Yes, but I don't have the details of what those would have been.

Senator SINGH: What services were previously offered by TAZREACH that are no longer available because of this reduction?

CHAIR: This is really getting into the weeds of a particular policy. I accept that these are legitimate questions, Senator Singh, but we are really outside of cross-portfolio. We can carry these questions over to when we have the health workforce on. Health workforce is not that far away.

Senator SINGH: I don't have any more, other than one question, so we could knock it over.

CHAIR: All right. I'll let you ask the question. Let's knock it over.

Mr Hallinan : I can take that on notice for you, Senator.

Senator SINGH: And also any jobs lost in the health sector workforce as a result of this reduction.

Senator McKenzie: Is that staff data?

Mr Hallinan : I don't think we'd be able to provide a response to that one. It's not information that we track.

Senator SINGH: You don't track job losses?

Mr Hallinan : An outreach program is, by its nature, taking somebody from an area and moving them to another area for the delivery of services in that location. They're usually employed in a home town, wherever that might be—it could be Hobart; it could be Melbourne—and they'll be sent out to provide an outreach service for a short period of time in the community. I don't imagine there would have been any major job losses associated with the terminating of that outreach arrangement, because they are, by their nature, employed in the location they usually live or reside.

Senator SINGH: Are you taking that on notice?

Mr Hallinan : No. I don't think I'll have information on jobs associated with those programs.

Senator SINGH: Okay.

Mr Wann : By way of clarification—and I guess this comes from not being a long-term Health person—we do have a mapping of flexible funds to programs, so that will be helpful in terms of the architecture. Also, I might have given the wrong impression. Flexible funds were not previously reported in portfolio budget statements at that level. They were a level underneath the PB statements. They're actually at a similar level. Neither the priority areas nor flexible funds were reported in the portfolio budget statements.

Senator SINGH: Mr Wann, are you able to table that page that you have?

Mr Wann : Absolutely.

Senator SINGH: Thank you.

Senator RICE: I want to start by asking about your department's implementation of the Australian Government Guidelines on the Recognition of Sex and Gender, which allow for record keeping to record genders other than male or female on databases and forms, and which support respectful relationships between gender-diverse, transgender and intersex people. The guidelines were meant to have been fully implemented by July 2016, but I'm aware that not all departments have done that implementation, so I want to know what steps the department has taken to implement the guidelines.

Ms Balmanno : We implemented the guidelines in the early part of the 2016-17 financial year. We included a non-binary gender option within our HR systems. We've also implemented e-learning modules within the department, which we encourage staff to undertake so they better understand the experiences of LGBTI people. And we're currently working with our LGBTI staff network to develop an LGBTI action plan.

Senator RICE: Is the e-learning available for people to undertake?

Ms Balmanno : Yes, it's available for all staff to undertake.

Senator RICE: Is there any mandatory training?

Ms Balmanno : Not at this stage, no.

Senator RICE: Do you track how many staff undertake that training?

Ms Balmanno : Yes, we can track that. I don't have that data with me.

Senator RICE: If you could take that on notice, that would be good. Does the department have outward-facing operations—that is, interactions with members of the public?

Ms Balmanno : Yes.

Mr McCabe : Yes, we do. One example is the My Aged Care system.

Senator RICE: And how have the guidelines been implemented in terms of your outward-facing operations—your dealings with the public?

Mr McCabe : We'd have to take that on notice to provide a detailed response, but specific to the system I mentioned, we have implemented additional fields for clients to add additional information regarding gender diversity.

Senator RICE: What training has been provided to people who are dealing with members of the public to encourage respectful relationships?

Ms Balmanno : We would have to take that on notice. Colleagues in the aged-care part of the portfolio may be able to answer.

Ms Beauchamp : And also, through our contracted providers through the Department of Human Services, I'll just confirm with them exactly what they're doing as well.

Senator RICE: Are there other programs like the My Aged Care that the department runs that also would be relevant, that the guidelines should have been implemented through?

Ms Balmanno : Most of our other systems that are externally facing or capture personal data in that way and are not run by the department. They're administered, for example, by the Department of Human Services.

Senator RICE: How about the various agencies that fall within the department? Do you track whether those agencies have implemented the guidelines?

Mr McCabe : No, we don't. That would be something we'd have to look at specifically.

Ms Balmanno : We do routinely share our approaches and our policies where we implement new training options. When a new HR policy or guideline starts, for example, we routinely make those available to the portfolio agencies so they can utilise that same information.

Senator RICE: Right. But you don't track whether they are actually—?

Ms Balmanno : No.   

Senator RICE: Would those agencies be where most of the outward-facing operations occur that the department's responsible for?

Ms Balmanno : Some agencies are outward-facing; some are not.

Senator RICE: Right. But there would be considerable outward-facing interactions with the community through those agencies?

Mr McCabe : The MyHealth record would be a good example with the Australian Digital Health Agency.

Senator RICE: Do you know, for example, whether they have fully implemented the guidelines?

Mr McCabe : I don't, off the top of my head, but we could ask them.

Senator RICE: Could you take on notice what you know about how well the various agencies that fall within the department have implemented the guidelines?

Mr McCabe : Yes.

Senator RICE: My second lot of questions is with regard to support for intersex organisations. There was a Senate inquiry into the involuntary or coerced sterilisation of intersex people in Australia. One of the recommendations for that inquiry was:

The committee recommends that the provision of information about intersex support groups to both parents/families and the patient be a mandatory part of the health care management of intersex cases.

So I want to know whether there is any federal funding given to intersex-led support groups.

Mr McCabe : We're not aware, specifically within our portfolio, of any funding or arrangements.

Senator RICE: So you'll have to take that on notice. I did ask a question in October estimates last year about funding for intersex peer-support services. The information I got back was that the department funded QLife, MindOUT!, ReachOUT and Qheadspace. Do you agree that none of these organisations, despite all the very good work that they do, are in fact intersex peer-support organisations?

Ms Beauchamp : We don't do anything around intersex peer-support organisations, but we do provide services, particularly through mental health, for the ones that you just mentioned.

Senator RICE: Given that Senate inquiry recommended that there should be mandatory connection with intersex support groups, is there any reason or has consideration ever been given to supporting intersex peer-support organisations, or any reason why there is no federal funding for these organisations?

Ms Beauchamp : I think that's really an issue that we'll have to address across a number of portfolios, but I can certainly take it on notice from a health portfolio perspective.

Senator RICE: I'm told that it would be through the health portfolio perspective. If there was funding to be available for intersex support organisations, it would be through Health, particularly given the ongoing issue of involuntary and coerced sterilisation of intersex babies and infants—

Ms Beauchamp : I'll take that on notice.

Senator RICE: and whether the department has got any plans to ensure the wellbeing of the intersex population.

Senator WATT: Ms Beauchamp, in relation to the 2018-19 budget, can the department confirm if any funding from other health outcomes went to outcome 6, Aged Care?

Mr Wann : In some of the packages, funding might have been appropriated to a various number of outcomes. For example, in the aged-care package there would have been some measures that were directed to other outcomes coming out of, for example, outcome 2 in the context of mental health. That would have been part of the ageing package.

Senator WATT: As an example, then: money has been shifted from Outcome 2, which is mental health, to aged care?

Mr Wann : No, the funding has gone to the respective outcomes. It's more the fact that, in terms of packaging, the target group for this particular measure is more in the aged end of the spectrum. It would form part of the ageing package, but it would be funded out of outcome 2.

Senator WATT: Right. So the funding that's been allocated and announced for the ageing package includes funding that is actually provided to other outcomes such as mental health?

Mr Wann : Yes, that's correct.

Senator WATT: Are there any other examples of funding in other outcomes that have been rolled into this ageing package?

Mr Wann : That's probably the biggest one. On page 32 on the Portfolio Budget Statements you see the package 'More Choices for a Longer Life'. It lists the various outcomes and programs against which funding has been provided.

Senator WATT: I see. For instance, money's come out of outcomes 2.1, 2.2 and 2.4 and has been moved across to this or rolled into this ageing package?

Mr Wann : Rolled into the ageing package; that's correct.

Senator WATT: Okay. And so 2.1 is mental health. 2.2 is—

Mr Wann : Indigenous, so Aboriginal and Torres Strait Islander health. 2.3 is health workforce. I think they're the only ones.

Senator WATT: 2.4 is listed as well, which is—

Mr Wann : 2.4 is preventative health disease support.

Senator WATT: Is any of that funding that's listed on page 32 new funding?

Mr Wann : Yes. This represents the change in funding for these particular outcomes and programs.

Senator WATT: It's not new funding for your department; it's new funding for ageing which has come from other parts of the department?

Mr Wann : No, each of these programs receives additional funding, so 2.1 in 2018-19 would receive $8½ million, 2.4 would receive $2.4 million and so on. So they do get additional funding.

Senator WATT: It's not that money that was already allocated to, for instance, outcome 2.1 has been shifted across to outcome 6?

Mr Wann : No.

Ms Beauchamp : In this table these are the net changes in the budget, so these are new figures. If there was a reallocation, it would probably have zero or a dash or something like that, but these are actually new numbers.

Senator WATT: Okay. Can you confirm whether there were any additional funds outside of the Health portfolio that went to outcome 6? Would it be these ones that we're talking about here? For instance, are there any funds from consolidated revenue—new funds—that went to outcome 6?

Mr Wann : In one sense, this shows the shift between consolidated revenue and into our appropriation both ways. So, if it's a positive figure, it's new money going into that outcome and program. If it's in brackets, it's going the other way.

Senator WATT: Okay. Obviously tomorrow we'll have a long time allocated to aged care in detail, but can the department confirm whether there was any funding reallocated from other areas within the ageing or Aged-Care portfolio?

There's been plenty of media about funding being reallocated from residential aged care towards the home care packages.

Mr Wann : Are you asking if there have been savings within that? We don't hypothecate in that sense, but you can see the net impact on the overall appropriations outlined on page 32.

Senator WATT: But it is the case that funding, for instance, was taken from residential aged care to help pay for the increase in home care packages.

Mr Wann : That's a slightly different matter. What happened in that instance is that you had two separate programs that were separately appropriated. Lisa's probably better placed to talk about the policy, but a policy decision was taken to combine those to provide flexibility. The intent of the new program was so that you can flexibly move money to where the demand for resi care or home care is. That's different to making a decision that reduces or increases either.

Senator McKenzie: In the previous government, Labor banked the savings out of aged care whereas we've made the conscious decision to retain all those savings within the Aged Care portfolio.

Senator WATT: Was there any new money for the new home care packages?

Ms Beauchamp : Yes. There's been money allocated for 14,000 new home care packages.

Senator WATT: My question was about new money as opposed to the money that was previously allocated to residential aged care.

Mr Wann : In the sense that the two appropriations have come together, that there's been a shift in funding from one area of less growth and demand to an area of greater growth and demand, yes, that's happened within that new program.

Senator WATT: Yes, but it's not new funding for aged care. You used to have funding for residential aged care in this bucket and you had funding for home care packages in that bucket. What you've said has happened is that they've been collapsed into one bucket so that the money can be used flexibly.

Mr Wann : Yes.

Senator WATT: My question was whether there was any new funding that wasn't in those buckets that has been put in to help pay for these home care packages.

Mr Wann : Funding had to be provided for the additional home care packages and, within this new program, there was a reduced growth in demand for residential care. That funding that would've normally gone there has shifted across within this new program.

Senator WATT: I'm very, very clear on that. What I'm getting at is that there was no new funding that wasn't already going to aged care that has been provided to pay for more home care packages. It's all come from existing resources that were spent otherwise.

Mr Wann : Yes. Resources were identified in the forward estimates for residential care, but the level of demand isn't as great, so, with the new program, yes, that funding has been reallocated.

Senator WATT: Aside from residential aged care, are there other existing funds in the ageing portfolio that have been redirected to help pay for the new home care packages?

Mr Wann : No.

CHAIR: Can I seek clarification here? My understanding is that all savings that the government has made in the Health portfolio have been reinvested back into the Health portfolio. That would include the aged care portion of the Health portfolio. Is it correct, Minister, that all savings have been reinvested?

Senator McKENZIE: Yes. Absolutely.

CHAIR: Can we compare that, then, with what happened under previous governments? Do we have any examples where that wasn't the case?

Senator McKenzie: My understanding is that the previous Labor government took savings out of aged care specifically and banked them rather than reinvesting in aged care packages.

Ms Beauchamp : I will also confirm that, in terms of the budget paper, there's a net increase in money going to aged care. I think Mr Wann was describing it as rather than looking at estimates variations and the like, we now have a much more flexible pool that is kept within the aged-care system and not lost to other parts of the budget. So not only has there been a net increase, but we now have a flexible pool to manage those priorities, and hence the allocations of 20,000 new places.

Senator WATT: I understand that. What I think we've been able to establish is that there is additional funding being provided to provide new Home Care Packages.

Ms Beauchamp : That's correct.

Senator WATT: That funding has come from reductions in funding to the residential aged-care sector?

Ms Beauchamp : No. There's been a collapsing of the two programs.

Senator WATT: Another word for redirecting.

Ms Beauchamp : In the past, I think any estimates variations would have been returned to consolidated revenue. Now, that money is being reinvested into new packages. I think the budget papers show, and our budget papers show, a net increase in aged-care funding.

Senator WATT: But not for the Home Care Packages?

Ms Beauchamp : I think across both the programs now there's a net increase.

Senator WATT: Yes, but not for the Home Care Packages. I don't think I could be any clearer that you have collapsed previous funding buckets. We've heard that several times. I get that. What I'm trying to establish is, is it the case that no new funding, aside from the money that was already there for residential aged care—that was never in your portfolio before—has been provided to pay for the new Home Care Packages?

Ms Beauchamp : There is new funding for the aged care Home Care Packages.

Senator WATT: Can you point to that for me in the budget papers?

Ms Beauchamp : There are 14,000 new Home Care Packages.

Senator WATT: I know that. How's it being funded?

Ms Beauchamp : Through the budget.

Senator WATT: By collapsing the two previous funding buckets into one?

Ms Beauchamp : I think that's one element, but I also mentioned that there'd been a net increase in appropriation to aged care.

Senator WATT: I understand that, but that's different thing to the home funding Home Care Packages.

Senator McKenzie: I think it's useful to unpack it—

Senator WATT: It's been unpacked. We've been unpacking it for the last 10 minutes.

Senator McKenzie: so you get a full picture of how we're able to provide such a comprehensive aged-care package.

CHAIR: I think we've been unpacking it so much the box is empty!

Senator McKenzie: They'll be nothing left for tomorrow—

Senator WATT: In terms of these decisions, which minister made the decisions around funding allocations in outcome 6?

Ms Beauchamp : The government made the decision through the budget process.

Senator WATT: And which minister?

Ms Beauchamp : It's a collective decision of cabinet.

Senator WATT: So which minister put forward these proposals to cabinet?

Ms Beauchamp : A number of ministers put forward the proposals through a task force.

Senator WATT: Minister Hunt?

Ms Beauchamp : He was one of the ministers.

Senator SINGH: Can you list the ministers?

Ms Beauchamp : I think there was a ministerial task force across Minister Wyatt, Minister McKenzie, Minister Hunt, the Treasurer—

Senator McKenzie: Mr Tehan—so a range of ministers were involved.

Senator WATT: The ultimate decision about which aspect of the aged care portfolio received this money, which minister made those decisions? Which minister decided this type of aged care gets this and this type of aged care gets that? Was there an individual minister, who ultimately—

Ms Beauchamp : I think it was a decision of budget and cabinet collectively.

Senator WATT: In terms of other non-budget measures across the ageing and aged care portfolios which minister makes those decisions?

Ms Beauchamp : Again, I mentioned a ministerial task force, and it was the collective decision of cabinet and the Expenditure Review Committee on how funds were allocated.

Senator WATT: Leaving aside the Aged Care Packages, for non-budget matters within the portfolio, which minister makes those decisions?

Ms Beauchamp : Could you give an example of a non-budget measure?

Senator WATT: I've never worked in this portfolio, but you have so I might need to rely on your memory. There would be dozens of decisions made by a minister in the portfolio every week that don't involve allocating this funding in this way, which minister is making those decisions?

Ms Beauchamp : I think the general thing—not rule or protocol—is where there's a change in policy, it's decided through cabinet and budget.

Senator McKenzie: On a day-to-day level, though, it's Minister Wyatt.

Senator WATT: Can you give me some examples of decisions that Minister Wyatt has made in the portfolio over the last month?

Ms Beauchamp : He's probably made a number of decisions with his delegation around proposals relating to some aged-care providers and Indigenous health providers.

Senator WATT: On the other hand, can you give me some examples of decisions in the Ageing portfolio that Minister Hunt has made over the last month?

Ms Beauchamp : I can't off the top of my head.

Senator WATT: Does Dr Studdert know?

Dr Studdert : As you've noted, Minister Wyatt is the Minister for Aged Care and makes the daily decisions around a whole range of matters. Just last week he introduced legislation into the House around quality standards. I think Minister Hunt and all the ministers in the portfolio are involved in budget decisions as part of the process that Ms Beauchamp has described.

Senator WATT: So budget decisions are made by this ministerial task force?

Dr Studdert : In the case of the ageing task force, yes, and the whole ageing package.

Senator WATT: That is headed by Minister Hunt?

Ms Beauchamp : Budget decisions and priorities and policy changes are made by cabinet.

Senator WATT: But the task force you talked about—which minister heads that?

Ms Beauchamp : That was a task force that was headed by the Treasurer, and it was the Expenditure Review Committee in cabinet that made the decisions.

Senator WATT: Does Minister Hunt receive copies of Minister Wyatt's briefings?

Dr Studdert : Not as a matter of course. If it is something that we would expect might be of interest to him, we would do that, but not as a matter of course, no.

Senator WATT: So significant matters are shared with Minister Hunt?

Dr Studdert : As we do with all the ministers in the portfolio.

CHAIR: Senator Smith has a few questions in this area, I believe.

Senator DEAN SMITH: Secretary, using budget moneys to give Australians greater choice about the type of care they might receive, whether it be in residential aged care or community aged care, is not a new budget initiative, is it?

Ms Beauchamp : I think when you're looking at the research that we have before us—

Senator DEAN SMITH: No, no. More specific than that: if you go to the 2010-11 budget paper, you will see, under Health and Ageing, a statement there at page 22:

The Government—

A Labor government, if I'm not mistaken—

will redirect funding of $247.7 million over four years from high-level residential aged care to high-level community aged care to ensure new high-level community aged care places …

It then goes on to say:

This measure will provide savings of $9.0 million … due to the lower costs associated with delivering care at home …

While increasing greater choice et cetera. Then again, in the 2011-12 budget paper, under the Health and Ageing initiatives, it says:

The Government—

Again, the previous Labor government—

will ensure additional high-level community aged care places are made available by temporarily adjusting the balance between high-level community aged care and high-level residential aged care.

Then—more alarming for people like Senator Watt—in 2012-13 the budget paper, when it talks about the Living Longer, Living Better initiative, says:

The Government will provide $955.4 million over five years …

And, importantly:

… of this amount, $454.0 million … has been re-directed from funding previously allocated to residential care.

In your previous evidence, Secretary, when you said that previously savings might have been directed to consolidated revenue, did you mean away from aged-care services, and would that have been an example of a shift to consolidated revenue?

Ms Beauchamp : Without having that detail—

Senator DEAN SMITH: I'm happy to table them.

Ms Beauchamp : that is correct, yes.

Senator DEAN SMITH: Thank you.

CHAIR: Given it's almost 11 o'clock, we will suspend for 15 minutes.

Proceedings suspended from 10:59 to 11:15

CHAIR: We will resume with the examination of the Health portfolio, cross-portfolio and corporate matters.

Senator WATT: I've got some general questions about the process of preparing for estimates. Ms Beauchamp, who comes up with the briefs that are included in your folder? Is that a departmental exercise or is it the minister's office, or a combination?

Ms Beauchamp : It varies for me as an individual. I grab bits and pieces from all over the place, whether they're question time briefs, media releases or a combination. Normally, in the department, we just go through what the issues of the day might be.

CHAIR: You bring the dusty folder down from the shelf!

Senator WATT: Do you set out a range of topics that you want to have briefs on or do people provide them to you unsolicited? How does it work?

Ms Beauchamp : Both ways.

Senator WATT: So some you ask for and others are provided to you by people in the department or the minister's office?

Ms Beauchamp : People in the department. We take this across the department and look at preparing within the department.

Senator WATT: What input does the minister's office have in suggesting topics that you should have briefs on; that kind of thing?

Ms Beauchamp : None to us. We do it in the department, given that we appear before Senate estimates three times a year.

Senator WATT: Are any of the briefs that you have drafted by ministerial staff?

Ms Beauchamp : No.

Senator WATT: It's all done by departmental staff?

Ms Beauchamp : Yes.

Senator WATT: Do you meet with the minister or his office prior to estimates to talk about topics that might come up and how to respond; those kinds of things?

Ms Beauchamp : We meet, for example, with Minister McKenzie to go through an outline of all the programs and subprograms that might be discussed.

Senator WATT: That's in the weeks leading up to estimates?

Ms Beauchamp : Days.

Senator WATT: Days leading up to estimates; okay.

Senator McKenzie: Not weeks!

Senator WATT: What coordination happens with either Minister Hunt or Minister McKenzie and their offices on the day of estimates itself?

Ms Beauchamp : What do you mean by 'coordination'?

Senator WATT: Do you catch up again beforehand, just to prepare for topics that might come up and how questions could be answered, on the day of estimates?

Ms Beauchamp : In my role, I'm talking to ministers on a regular basis. We talk about things that might be in the media or, for example, things that you give us a heads-up that you are going to raise.

Senator WATT: I meant to check that you've got people lined up for that.

Ms Beauchamp : We'd make sure that that information was known across the portfolio.

Senator McKenzie: I meet with my staff before estimates. We had a chat this morning about what we thought was going to happen.

Senator WATT: And do you or Minister Hunt or their staff meet with Ms Beauchamp on the morning of estimates as well, just to talk about possible questions and how they should be dealt with on the day of estimates?

Senator McKenzie: I think we caught up this morning.

Ms Beauchamp : Yes, we caught up this morning and just went through: have we got the folder; have we got all of the information we need; what are the likely questions to be raised; what's running in the media, for example; and being clear about, given it's a two-day estimates, what's going to be raised in day 1 and day 2.

Senator WATT: Does any of Minister Hunt's staff or Minister McKenzie's staff ever send you emails through the hearing with suggested answers to questions?

Ms Beauchamp : Not suggested answers to questions, no.

Senator WATT: Or clarifications or other information? Is anything emailed to you from ministerial staff?

Ms Beauchamp : No, I get advice SMSs from my staff occasionally.

Senator WATT: From departmental staff?

Ms Beauchamp : Yes.

Senator WATT: And do you get any SMSs from ministerial staff?

Ms Beauchamp : No.

Senator WATT: During estimates?

Ms Beauchamp : Not normally, no. Not generally, no.

Senator WATT: And no other platforms—Wickr, WhatsApp or any of those sorts of things?

Ms Beauchamp : I haven't got my iPad open. No, I don't.

Senator WATT: So there's no means by which ministerial staff provide you with suggestions about how to respond to questions or anything like that?

Ms Beauchamp : No, I'm trying to do this to the best of my abilities.

Senator WATT: No problem. I think that's it for us for cross portfolio.

Senator DI NATALE: I have a few more questions around the issue of out-of-pocket cost. Professor Murphy, are the terms of reference for the advisory council publicly available?

Prof. Murphy : Yes, in the media release it listed the names of the members. I'd have to take it on notice whether we actually published the terms of reference, but there's no reason why—we'd be very happy to provide them. They're not a secret document at all.

Senator DI NATALE: Can I ask you to perhaps take the terms of reference on notice?

Prof. Murphy : Yes.

Senator DI NATALE: Great. You're happy to table that.

Prof. Murphy : Yes.

Senator DI NATALE: With the composition of the council, who's on it?

Prof. Murphy : There is a representative of the Consumers Health Forum, a representative of Private Hospitals Association, a representative of Catholic Health Australia, a representative of the health insurers and a number of medical leaders: the president of the College of Surgeons; a representative of the AMA Federal Council, the president of the College of Obstetricians and Gynaecologists, the president of the College of Anaesthetists, the president of the College of Ophthalmologists, the head of the Neurosurgical Society and the Orthopaedic Association, and a representative of the College of Physicians.

Senator DI NATALE: Why were those specific specialities chosen?

Prof. Murphy : We wanted to keep the committee reasonably small. We wanted to feature, clearly, some of specialities where out-of-pocket costs were seen to be an issue, so that's why we chose urology, orthopaedics, surgery and obstetrics, and, obviously, the College of Physicians representative to cover the others and, obviously, the AMA is a key stakeholder. And, then, the non-medical representatives—that's pretty self-explanatory.

Senator DI NATALE: So really, the only consumer rep is from the Consumers Health Forum?

Prof. Murphy : Yes, but she has a group that advises her.

Senator DI NATALE: It's a big committee.

Prof. Murphy : Yes.

Senator DI NATALE: There's only one consumer rep.

Prof. Murphy : We had this discussion. The reality is that if you were trying to establish whether there was a problem or not, you would have a lot of consumers. We came into this committee with the clear position that there was a problem and it needed solving, and that the solution needed broad buy-in from medical leaders. That's why—

Senator DI NATALE: But doesn't it have to satisfy the needs of consumers first and foremost? It's not the needs of doctors.

Prof. Murphy : It exactly does.

Senator DI NATALE: And, of course, we go back to that concern that if you're going to put the onus back on consumers to be more literate, to have more information and to shop around, whether those solutions are workable should be up to consumers, not up to doctors.

Prof. Murphy : That is a key purpose of the committee, and that's why the consumer representative has convened a group of consumers to reality test every product we come up with. They feel that it's perfectly fine for them to test what we come up with in their own group, and she can report back on that basis, and she feels perfectly adequate in terms of representation of consumers. She engages broadly with the information that we give her.

Senator DI NATALE: I think there have been a number of requests for a Productivity Commission review. Does the committee have a view on that?

Prof. Murphy : The committee hasn't discussed that issue, no. The committee has focused entirely on developing a transparency solution and getting rid of hidden fees and booking fees. That's pretty much what its purpose is.

Senator DI NATALE: So, I'll wait for the terms of reference to be distributed.

Ms Beauchamp : And just to confirm, the terms of reference are on the website.

Senator DI NATALE: Great. That's easy. I can go and check that out.

Ms Beauchamp : But we do have a copy here, if you want one tabled as well.

Senator DI NATALE: Thank you. I just want to go back to that issue—and I think we traversed it when we were talking about radiotherapy—I absolutely accept that it's patient choices here; we've got a mixed system, and there is a significant number of private operators, private hospitals, private providers and so on. But isn't the most effective way, as a consumer, to be sure that you're not going to be faced with out-of-pocket costs to have an effective, well-funded public health system?

Prof. Murphy : As I said, we're working on the premise that the community has expressed a view for a mixed private-public health system. It's not my role to make a policy opinion on what sort of system we should have. We're working on the basis that we have a hybrid system.

Senator DI NATALE: But, with respect, the community hasn't expressed a view. The community's been forced into a view because they're penalised if they don't take out private health insurance if they earn over a particular amount, and there are incentives for them to take out private health insurance. So, it's not a value-free choice. This is a choice that is being influenced by the incentives and disincentives within the system.

Prof. Murphy : I don't think that's something I should comment on.

Senator DI NATALE: Okay. I will leave it there. I have a few other questions, but I can deal with those through private health. Thank you.

Mr Wann : If I could make another correction: I might have mentioned a number of 200 priorities, or thereabouts. My staff have got back to me via text and have amended that. It's actually 63 administered priorities—

Senator SINGH: Wow—that's a big difference!

Mr Wann : covering 1,008 cost centres. In bill 1 there are 44 priorities and 832 cost centres. In bill 2 there are two priorities and 39 cost centres. In the special accounts there are two priorities and 45 cost centres. In the special appropriations there are 15 priorities and 92 cost centres. But we will come up with a full list. I apologise for that.

Senator SINGH: So, where did you get the figure of 200 from?

Mr Wann : It was a voice from the back. Next time I'll make sure. Sorry about that.

Senator SINGH: It's quite a difference. Well, at least there's less for you to take on notice now.

Mr Wann : Well, yes.

Ms Beauchamp : It's still a lot.

Mr Wann : It is still a lot. And it is mostly in bill 1, so I was kind of right about that.

Senator GRIFF: I have a very brief question—just some clarification, really. Cannabis oil has been approved for prescription for patients with conditions such as severe unresponsive seizures. I've heard from a constituent whose son, who relies on the disability support pension, is paying $612.50 plus $100 postage for a 25-millilitre bottle for his seizures, and he goes through four millilitres a day. Is there a measure whereby cannabis oil is or could be publicly subsidised?

Ms Beauchamp : Chair, this is not cross-portfolio.

Senator GRIFF: The question actually is, 'Where does it fit?'

Ms Beauchamp : But we have got—

Senator McKenzie: It's 5.1.

CHAIR: Insofar as Professor Skerritt can answer the question quickly, if it needs to be answered in 5.1, then—

Senator GRIFF: I don't want any more detail apart from the fact of where it would actually sit.

Prof. Skerritt : The Commonwealth government only subsidises medicines following a recommendation from the Pharmaceutical Benefits Advisory Committee to the minister, and those medicines have to be registered by TGA. There is one can cannabis product registered by TGA. There are a number that are currently unregistered products, some of which are going through clinical trials leading towards registration. Some states and territories, such as Tasmania and Victoria, have schemes where they do provide some compassionate access and provision of the costs. What I would suggest your constituent do is essentially shop around. There is a range of cannabis products that have been brought into the country and, because of that competition, their prices have dropped. The first three crops of commercial cannabis have also been harvested in Australia and, while it will be a little time before they're converted into products, we expect local cultivation will also result in a decrease in the price of those products.

Senator GRIFF: Thank you.

CHAIR: We will move on from cross-portfolio. We shall go to outcome 1: 'Health System Policy, Design and Innovation'; program 1.1. Senator Singh, we're going to start there.

Senator SINGH: I want to ask some questions relating to the Medical Research Future Fund. When the government announced the MRFF in the 2014 budget, it said the MRFF would disperse $1 billion a year by 2022-23. Is that still the government's commitment?

Ms Edwards : Can I check the question, please, Senator, in terms of the disbursements from the MRFF? You're after an answer about how much has been dispersed?

Senator SINGH: Yes, as it said in the 2014 budget. It said that $1 billion would be dispersed each year by 2022-23. I'm just checking that's still the case.

Ms Kneipp : Every year in the PBS statements for both Health and Finance, the profile is expanded to another year. The recent forward estimates for the MRFF are published on page 47 of the Health PBS. It effectively takes us out to the year 2021-22, with close to $2 billion available in MRFF disbursements.

Senator SINGH: So there's $2 billion to disperse in this current financial year. Is that what you're saying?

Ms Kneipp : No—correction, Senator: it's over the forward estimates, from the year 2016-17 to 2021-22.

Senator SINGH: So there's $2 billion to disperse each year in the forward estimates?

Dr Hartland : That's accumulative over that period, from 2016-17 to 2021-22.

Senator SINGH: That level of disbursement depends on a $20 billion capital fund. In the 2018 Budget Paper No. 1, statement 7—I'll take you to page 7-18—it says the MRFF 'is expected to reach a balance of $20 billion in 2020-21'. Is that your understanding as well?

Ms Kneipp : That is our understanding based on modelling provided by the Department of Finance. As you know, the Department of Finance is the owner of the legislation for the MRFF Act 2015, as well as managing the fund.

Dr Hartland : Senator, these aspects of the balance of funds are within the Department of Finance portfolio. Their portfolio budget statement provides details of the credits and balance in the fund.

Ms Kneipp : For reference, that's on page 32 of the Finance statement.

Senator SINGH: In relation to page 47, you referred to the $2 billion accumulative figure. Is it correct that the government is committed to $1 billion a year from 2022-23, after the forwards? Is that still the commitment? That is what was in the 2014 budget announcement.

Ms Edwards : We can provide you with information about the disbursements available up until 2021-22, and the amounts that have been invested to date over that period. We haven't got any figures in relation to what's happening after that event. Issues to do with the performance of the fund and so on are matters for the Department of Finance.

Ms Beauchamp : But that's certainly the target, Senator. When you look at the forward estimates in terms of disbursements—in 2020-21 we're well on the way there, with $642 million identified in the Finance portfolio budget statements as disbursements from the MRFF.

Senator SINGH: I was just asking about 2022-23 and if it's still a commitment of $1 billion a year from that date.

Ms Beauchamp : That's still the target, and it's outside the forward estimates.

Senator WATT: But it's only a target. There's obviously a difference between a target and a commitment.

Ms Edwards : Matters in relation to disbursements—what's available over the fund—really should be directed to the Department of Finance. We're certainly aiming towards having disbursements up towards $1 billion a year, but we can't comment on the detail of them.

Senator SINGH: If I take you back to Budget Paper No. 1 statement 7, it also shows that the balance of the MRFF is $7.1 billion as of 31 March 2018. How will it reach $20 billion, which is obviously another $13 billion in just two years?

Ms Kneipp : Again, Senator, we direct you to the Finance portfolio statement, which shows the modelling in terms of credits to be deposited into the endowment fund to allow it to reach that $20 billion target.

Senator SINGH: I understand that the government's previously pushed the $20 billion target back—I think back one year, from 2019-20 to 2020-21. Will you still have to push it back again?

Dr Hartland : This is a matter for the Department of Finance.

Senator WATT: But it's in your budget papers, isn't it?

Dr Hartland : No. The credits and balance of the funds are in the Department of Finance budget papers.

Senator SINGH: Well, you must be able to tell the committee where the $13 billion is coming from.

Dr Hartland : No, Senator. This is a matter that you'll have to ask the Department of Finance about. They run this aspect of the MRFF.

Senator SINGH: It's under the government's contributions to the MRFF in PBS No. 1. Did this department have nothing to do with that?

Dr Hartland : We don't manage the credits or the balance of the fund. The Department of Finance manages the credits into the funds and the balance of it.

Senator WATT: Are you concerned that it won't reach $20 billion as was initially predicted?

Dr Hartland : I think that's a softer form of the previous question, Senator.

Senator WATT: Yes, but I'm asking you from the Health Department's perspective. It's your responsibility to allocate these funds. Are you concerned that the $20 billion won't be there?

Dr Hartland : The Department of Finance's budget statements show an accumulation of the fund that gets to $20 billion by 2020-21. We would rely on that statement.

Senator SINGH: Well, all of the government's contributions to the MRFF so far have come from cuts elsewhere in the Health portfolio. Does the portfolio expect to contribute all of the remaining $13 billion that's needed to reach this $20 billion?

Ms Beauchamp : Senator, can I clarify the previous statement about disbursements coming from cuts to the portfolio? I'm not sure where you got that information from.

Senator SINGH: Are you saying that that's not the case?

Ms Beauchamp : That's not the case. The disbursements come from the fund, not from elsewhere in the—

Senator WATT: We're not talking about the disbursements from the fund; we're talking about contributions to build up the fund.

Ms Beauchamp : As Dr Hartland said, I think the Medical Research Future Fund Act 2015 is administered by the Department of Finance, and it's up to the Department of Finance to source the contributions from the Commonwealth government across government.

Senator SINGH: But the contributions for this fund have come from the Health portfolio. We are asking the Department of Health, because this is the Health portfolio, about those cuts to the Health portfolio in creating the fund—

Dr Hartland : The fund's created by realised savings from the Health portfolio. The Department of Finance makes that calculation.

Senator SINGH: Yes, realised savings of the Health portfolio. My question is specifically about whether or not the Health department expects to contribute to some or all of the remaining $13 billion to make up this fund.

Dr Hartland : These would be previous savings measures announced and dealt with by either parliament or administrative action, and the Department of Finance's role is to calculate what effect those savings have had and what proportion goes to the MRFF fund.

CHAIR: Senator Singh, you're asking for the official's opinion on future government policy.

Senator SINGH: No, I'm not asking for opinion.

CHAIR: I think you are, actually.

Senator SINGH: No, I'm asking whether savings are going to come from this portfolio to contribute to the health fund.

CHAIR: It's a hypothetical.

Dr Hartland : A savings measure will have effect over time. The Department of Finance calculates what that effect is and what proportion of that can be provided to the fund.

Senator WATT: Have you had any discussions with the Department of Finance about future cuts, reallocations, transfers or whatever term you want to use that may be made within the Health portfolio to fund contributions to this research fund?

Ms Edwards : No, we haven't.

Senator WATT: There have been no discussions?

Ms Edwards : No, there are existing measures in previous budgets that set up and contributed to the MRFF. It's now managed by the Department of Finance. We have had no discussions and are not aware of any proposals for future measures affecting the Health portfolio to factor into the MRFF.

Senator SINGH: Is the department aware of where money in the Department of Health will come from to contribute to the MRFF?

Ms Edwards : The MRFF was set up under previous budget measures, and those are continuing and being managed by the Department of Finance.

Senator SINGH: Can you rule out further cuts to Health as the government tries to get this $20 billion in capital fund?

Senator McKenzie: 'Further cuts to Health,' Senator Singh?

Senator WATT: In addition to the ones you've made.

Senator SINGH: Yes, because there have been cuts to Health to contribute to the Health portfolio.

Senator McKenzie: I think we've been really, really clear this morning that there are no cuts to the Health portfolio.

Senator WATT: The officials just said that this research fund is being funded by cuts, transfers, reallocations—pick the synonym you want other than 'cuts'.

Senator McKenzie: I thought 'redistribution' might be one that you like, Senator Watt.

Senator WATT: Okay, redistributions. But this research fund has been funded from redistributions within the portfolio. That's the cut we're talking about.

Senator McKenzie: Which are not cuts. Nothing's going back to consolidated revenue.

Senator WATT: What is a cut?

Senator McKenzie: Under your previous government, they would.

Senator WATT: How do you define a cut?

Senator McKenzie: They are defined as cuts, the cuts that your former government made in the Health portfolio.

Senator WATT: Not for this fund. It's all yours.

Ms Edwards : To be clear, we're not aware of any proposed measure, nor should we be, and there is no existing measure other than those set out in previous budget papers of contributions to the MRFF. It's not something we've had any discussions with Finance or anyone else about.

Senator SINGH: The Finance portfolio budget statement shows the total available from the MRFF in each year. Can you tell me how much of this has already been committed to particular disbursements?

Ms Edwards : Yes. Of the just over $2 billion available in disbursements since the establishment of the MRFF, there's been $1.77 billion committed or announced for investment out of the MRFF.

Senator SINGH: What year was that?

Ms Edwards : Over the duration of the fund.

Senator SINGH: Let's go through it. In 2018-19, $214.9 million is available. How much of that has been—

Ms Edwards : We might start in 2016-17, which was the first year of disbursements being committed, which was $18 million. In 2017-18, $143.4 million. In 2018-19, $236.2 million. In 2019-20, $332.1 million. In 2020-21, $369.6 million. In 2021-22, $233.6 million. There have also been commitments in relation to out years of $437.5 million, taking us to the total of $1,770.4 million.

Senator SINGH: Okay. The budget papers appear to include around $1.6 billion in further MRFF disbursements across two measures. Is that right, or are some of the disbursements counted in both measures?

Dr Hartland : We can take you through the government's recent announcements in the budget on MRFF funding.

Senator SINGH: What I'm after is a breakdown of spending by disbursement. and year over the next 10 years. I'm happy for you to take that on notice because we might be here a while.

Ms Kneipp : That's all on the public record, and the budget fact sheets are as well. A major component of that was the National Health and Medical Industry Growth Plan, which effectively is about $1.3 billion, and then there are a further $500 million of commitments for other MRFF-related projects. The minister has chosen to articulate those programs around four themes—patients, researchers, missions and translation. If you would like an easily captured table that summarises all the programs and their forward estimates, we can put that together for you.

Senator SINGH: That would be good. Is it correct that some of the disbursements are counted in both measures? That was the previous question I asked about the $1.6 billion in further MRFF disbursements?

Dr Hartland : The fact sheets and the measures that the government announced all contain a number of programs, but there's no double counting.

Senator SINGH: As I recall, the process for MRFF disbursements is roughly that the Australian Medical Research Advisory Board develops a five-year strategy, currently for 2016 to 2021.

Ms Kneipp : Yes.

Senator SINGH: The board develops two-yearly priorities, currently for 2016 and 2018. The board makes recommendations to the minister in disbursements that fit within the strategy and priorities, and then the minister makes disbursements. Is that correct?

Ms Kneipp : Effectively. The act requires this board to conduct a national consultation with the sector and the community about how to articulate those priorities, and the government makes the decisions. The board does not influence government decision-making about how the disbursements are made. In fact, as you got those years right, the current set of priorities—the inaugural priorities—are 2016-18. In July and August of this year, the board will start another national consultation to develop the second set of priorities for the MRFF.

Senator SINGH: Were all the disbursements in this budget recommended by the board?

Ms Kneipp : Again, the board doesn't recommend how to make the disbursements. It sets priorities, and the government takes those priorities into consideration as the board's advice when deciding how to make the disbursements and associated commitments.

Senator SINGH: How did these disbursements come out about, then? On what basis did the minister make disbursements?

Ms Kneipp : The minister has some conversations with the board, but, at the end of the day, program design is something that is done in consultation with the department and the minister's office.

Senator SINGH: Not the board recommending—

Dr Hartland : The board doesn't recommend specific programs.

Ms Kneipp : They advise.

Senator SINGH: Is that the case for all the previous disbursements as well?

Ms Kneipp : Correct, yes.

Senator SINGH: So the board advises?

Ms Kneipp : Yes, and the chair of the board, Professor Ian Frazer, is very clear publicly that his role is not to decide where the money goes but to advise on how to best use the money in program design.

Senator SINGH: And then the minister decides?

Ms Kneipp : Yes. Ultimately, it's a decision for government.

Senator SINGH: Can you explain the $20 million for the Australian Medical Research Advisory Board itself?

Ms Kneipp : Those funds are not actually taken out of the MRFF because the MRFF Act only requires that funds are used to fund research directly. But the advisory board is taking on a much greater role in oversighting not the implementation but the direction of the MRFF. With the industry growth plan now in place, as well as the significant investments in missions—in particular, the Genomics Health Futures Mission—the government's made the decision that the advisory board can play more of a governance and oversight role to some of these investments to ensure the return on value.

Senator SINGH: It says, in that part of the budget, that the $20 million is to support the Australian Medical Research Advisory Board to develop strategies and priorities for health and medical research and innovation. That seems a lot.

Dr Hartland : The MRFF is a slightly different program to some other research funding programs. There's a high expectation about public consultation and consultation with expert groups for the board. There's also considerable expectation around actively managing the program and the grants so that they produce pay-offs in terms of clinical discoveries and techniques and benefits to the industry. In essence, the government felt that more resources need to be put into those aspects of managing it to make sure that the program's successful.

Senator SINGH: So you're saying developing strategies and priorities includes consultation?

Ms Edwards : Yes, it can.

Dr Hartland : Yes, that's right.

Ms Beauchamp : That $20 million is a 5-year figure. It's not a normal forward estimates figure. One of the big initiatives announced in the budget was $1.3 billion for the Health and Medical Industry Growth Plan, which was in the Treasurer's statements. That has about five key elements. I think the money that you're speaking about is making sure that the advisory board takes a more active role in implementation of each of those measures under the growth plan. Some of the money does extend beyond the five years as well. One of the things I think government wanted to be assured about was implementation of the Genomics Health Futures Mission, the Frontier Health and Medical Research Program, five years, the rare cancers and rare diseases trials, the Targeted Translation Research Accelerator, and $94 million over the four years for industry research collaboration. So there's a big task in that delivery of the industry growth plan. $20 million has been set aside to help the board and make sure the board can oversight and monitor developments around that industry growth plan.

Senator SINGH: It just seems disproportionate, if you look by way of comparison. The department is only being allocated $2.8 million to administer this measure, compared to $20 million for—

Dr Hartland : The $2.8 million is a specific component. It's one aspect of one of the tasks that we need to do. It's effectively some funding to allow us to do some consultation for a second-pass business case on ICT. It's not the totality of the department's administrative effort in relation to the MRFF.

Ms Kneipp : That particular allocation is attached to the genomics mission.

Senator SINGH: This budget does make some disbursements that run for 10 years. Ten years is several MRFF strategies and priorities away and, dare I say, several governments or elections away, or both. How can the government commit to funding in 10 years when it doesn't know what the board's strategy and priorities will be, let alone what disbursements the board will recommend at that time, all those light years away? Doesn't that contravene the process that you've just described?

Dr Hartland : No. In one aspect, it's an essential component of the MRFF, in the sense that one of the things that's different about the MRFF is that it's intended to be a more targeted and purposeful granting process than some other granting processes and to have a longer-term impact on the medical research and technology industry. As a part of that, in some areas the government's wanted to make clear its longer-term goals for investment in particular areas to give industry and researchers certainty that there'll be ongoing funding available for projects that can often take quite a bit of time. In some areas, you see some projects suffering because there's been a sense that researchers won't go into the area because they feel that there's not going to be long-term funding available to them, so their careers might suffer in the future. I think the minister has wanted to identify some areas where he's committed to a longer-term funding response to give the industry and researchers certainty that there'll be support for that area of research into the future.

Ms Kneipp : If I could add, Professor Ian Frazer talks about the MRFF being a transformational opportunity for the health and medical research sector in Australia, in which we have a very strong global reputation. Commitments through 10 years and missions with bold targets are one way of stimulating the sector and attracting talent and building jobs and growth in Australia and collaborating internationally. The board has taken a perspective in their five-year strategy to focus on priming the entire pipeline, from idea to proof-of-concept through to translation and commercialisation. One sure way to do that is to make longer-term commitments.

CHAIR: One of the criticisms of this area in the past has been that research has been constantly chasing the next round of funding to continue studies going forward into the future.

Ms Beauchamp : The fact that this whole area is governed by an act that went through parliament was to provide that longer-term certainty, as well.

CHAIR: I have some questions on this area. Is there a global figure on how much the government's committed to spending on health and medical research? Is there a headline number?

Ms Beauchamp : Total portfolio research funding figure over the forward estimates, not including the longer term that we've just spoken about, is in the order of $6 billion research effort over the forwards.

CHAIR: I assume that would include the direct disbursement to the National Health and Medical Research Council?

Ms Beauchamp : It includes the disbursements through MRFF, but also the National Health and Medical Research Council annual funding as well.

CHAIR: That's what I meant—they get direct annual funding. Of the $6 billion, what percentage is that?

Ms Beauchamp : It's probably around $3.4 billion.

Ms Kneipp : On average, NHMRC is allocated around the $800 million mark. That figure that the secretary mentioned also includes the Biomedical Translation Fund. So the NHMRC, MRFF and the Biomedical Translation Fund are the key components.

CHAIR: So NHMRC is around $3½ billion, $2 billion from the MRFF, and the Biomedical Translation Fund is—

Ms Kneipp : $250 million, but remember that fund is leveraged with private capital, so it's effectively a $500 million proposal.

CHAIR: When was the Biomedical Translation Fund—what's the establishment process for that?

Ms Kneipp : It was announced in December 2015 under the National Innovation and Science Strategy. It was one of the key initiatives under that. Following a process of identifying fund managers, of which there are three, it began operation in January 2017. Basically, the fund managers go out and find the deals for advanced commercial-ready health and medical research innovations. They have to match the Commonwealth's investment with private-sector capital. So far to date, they've done nine deals at a value of about $42 million. They can invest these funds over a period of seven years.

CHAIR: Is that performing as expected, or better or worse?

Ms Kneipp : I'd say it's on track. We're pretty happy with the performance.

CHAIR: Is that something that we're expecting to ramp up over time, or is that a baseline that's just going to continue at that level?

Ms Kneipp : The idea of the BTF was to stimulate the venture capital sector and increase Australia's ability to invest in good-quality late-stage research. If I take you back to the MRFF and the MRFF strategy, a lot of the programs that are coming out in the disbursements around the MRFF are about priming that entire pipeline. We're effectively BTF priming throughout that pipeline, so that more great Australian ideas get to that commercial-ready space. It has potential to grow, but the BTF is a long-term investment, obviously. The deals can be made over seven years, and the exit strategy is 15 years.

CHAIR: The other area I wanted to ask about was the Genomics Health Futures Mission. That is a mouthful. Those who have watched estimates know I have an interest in genomics research. What is that going to do?

Ms Kneipp : The Genomics Health Futures or the genomics mission is a commitment of $500 million. The government is looking to also leverage those funds, which we're trying to do always with the MRFF. A good example is the Australian Brain Cancer Mission, where we've attracted near-matching philanthropy to that mission. Genomics is organised around six central themes. The mission will focus on the development and expansion of flagship studies focusing on rare cancers, rare diseases and complex conditions. This is where genomics is proving to have the greatest impact at the moment. Clinical trials—expanding pre-clinical and phased trials over the years. Influencing and increasing the workforce and the research capacity in this space. Commercialisation—this is where in the genomics mission we want to try and leverage some private capital, industry as well as philanthropy, to ensure that we're well positioned as a nation to harness this technology. Ethics, legal and social are significant issue, obviously. We need to bring the community along with us in the development of precision medicine, because it's destined to change the future of the healthcare experience. And then data analytics and issues around privacy and custodianship of genome data and how that fits into the entire health system.

A couple of weeks ago the minister announced the establishment of a steering committee, again to be chaired by Ian Frazer. It's a time-limited committee of six months. Their task is basically to design the architecture of the mission and its operational mandate. It will deliver that back to the minister and through government they'll make some final deliberations about how the mission will roll out.

CHAIR: Does that structure that you just described mirror similar examples in the past, or is this a new approach?

Ms Kneipp : I guess missions are a new approach. Missions were also touched on in Innovation and Science Australia's recent strategic plan for 2030. It called for bold new missions, as you may be aware. Other nations are heading down this way. The United States has its cancer moon shot, and the UK also has a very big commitment to harnessing genomics and embedding precision medicine and healthcare. These are increasing trends that nations are taking for technologies that have great potential, and we just need to figure out how to embrace them in our system and increase access for Australians.

CHAIR: Finally on this, can you take me through the diabetes and heart research accelerator? Is that going to have a similar mission structure? How is that one going to work?

Ms Kneipp : We talk about there being along the research pipeline two problematic valleys. One valley is where a researcher or a team has a great idea but they don't have the funds or the resources to prove that idea, to bring it to a proof of concept and then start it down the pathway to trials. And the BTF is on the other side, where you've proven the idea through trials but you need commercial energy and capital to bring the concept to market. The accelerator is a program designed to fast-track initially diabetes and heart disease ideas through to proof of concept and to get those ideas into trial-setting where they can attract more private capital. It's another attempt of the MRFF trying to leverage funds by attracting industrialists and philanthropy to increase efforts in this space, because obviously those are very challenging chronic disease spaces. There is an advisory group that's been established that the MRFF advisory board is involved in trying to develop the program design.

CHAIR: Has any work been done on the level of growth of employment, new researchers, that will be needed to fulfil this investment? Do we have any idea about that?

Ms Kneipp : A key foundational program that's emerging in the MRFF is investing in clinical researchers. In fact, over the six years $76 million has been made available under the MRFF. The fund is actually working with the National Health and Medical Research Council to ensure there are more fellowships out there to attract more Australians into the research space. We hope, as we invest in these various programs, that more people will decide to choose a life of research, or become a clinical researcher, because, essentially, these ideas will eventually become the jobs of the future and the new businesses that are created. It's all about supporting STEM.

CHAIR: Obviously, if you're going to invest this money then you need to have a pipeline of people coming through who can actually perform the research. Have we quantified that in any way?

Ms Edwards : In relation to the National Health and Medical Industry Growth Plan, which is an element of the MRFF, we've done some work and had some people help us do some calculations, and it's estimated to inject $18 billion into the Australian economy and cement our place as a world leader in this industry. It's also been estimated that there will be 28,000 new jobs, for a minimum of 130 new clinical trials, and a 50 per cent increase in exports, new markets and global market leadership in biotechnology, medical devices and pharmaceuticals.

CHAIR: Great. So we actually have considered how we're going to boost the workforce to supply the research that we need to improve our health system into the future?

Ms Edwards : The approach to research will be both fundamental in saving lives and helping individual Australians but also an important part of putting us at the forefront of what is a really modern, high-tech industry.

CHAIR: Excellent. Thank you.

Senator DI NATALE: Following on from Senator Singh's questions, has the department received any feedback from the research community that the process for disbursement is unclear? That's the message we're getting repeatedly from the medical research community—that they just don't have clarity about how the fund's going to be allocating its money.

Ms Kneipp : Just the other week, the Australian Medical Research Advisory Board met with peak bodies from the health and medical research sector and others, and this was a focus of the conversation—the need to ramp up our communication strategy around the MRFF. It was a very productive conversation. You may have noticed that we've actually launched a new website in the beta format, which we're using as a platform for improving that communication. In fact, we're hoping to move towards having a little working group that supports the advisory board to flag where there are gaps in knowledge and how we can quickly get those messages out.

Senator DI NATALE: I don't think their issue is one of communication; it's actually one of clarity of knowing how these issues are being made—what the basis of the allocation of funds is. I understand it's a ministerial decision ultimately, but there doesn't appear to be any clear framework that ensures the medical research community knows how the money is allocated and therefore how they themselves can decide to structure the work that they do. What work is being done, not on communicating, but on clarity around the framework?

Dr Hartland : I think the government's announcements, many of which go beyond the forward estimates period, provide a clarity around the framework that the government is using to make disbursements.

Senator DI NATALE: What does that mean?

Dr Hartland : It means that the government's announced the framework that it's using for disbursements in the budget.

Senator DI NATALE: Talk me through that.

Dr Hartland : The government's announced, for example, a commitment to a Genomics Health Futures Mission—

Senator DI NATALE: So, do we take that as: this is now going to be a central focus of the disbursements of funds for the fund, or are we looking at that as a standalone allocation of funding? The point is: we're hearing this from the researchers. It's not that we're asking you on behalf of ourselves in this space; it's actually the research community who are saying this to us repeatedly. I can't tell you how many functions I go to where they say: 'We just don't know how the money's being allocated. We don't know what the basis is. We don't understand the framework. We see these announcements. They sometimes appear to be disconnected. They're sporadic. We just don't have clarity.'

Ms Kneipp : Yes.

Senator DI NATALE: Are you hearing the same feedback?

Ms Kneipp : Yes, and we are working on that; I can assure you of that. The first disbursements from the MRFF made in 2016-17 were for one year only. The next lot of disbursements that have come in and around the budget just passed are four to five years in duration. So, what you see emerging are foundational programs, and, for the sector itself, a sense of routine. If you look at clinical trials, an additional $248 million over the next five years has been announced, which means every year there will be a round for clinical trials. The fellowships commitment goes over the next five years. Every year there will be opportunities through the NHMRC to hold an MRFF fellowship. It's creating a sense of routine which we didn't have with the first disbursements but we are trying to program into the future. The other thing, too, is we need to take the decisions that the government makes around disbursements, translate them into programs—design the program—and then communicate the opportunities to the market.

Senator DI NATALE: So it's fair to say, then, that the government's announcements around disbursement drive the priorities, or the programs?

Ms Kneipp : The programs.

Senator DI NATALE: The programs that sit underneath that?

Ms Kneipp : Correct.

Senator DI NATALE: So, ultimately, the minister can, at a whim, decide to put a hundred million bucks into project X, and then you retrofit that with the programs—

Ms Kneipp : It has to be consistent with the priorities that the advisory board has set.

Ms Edwards : It's important to note that all the programs to date are entirely consistent with the independent medical research and innovation priorities that were developed. There is a real consistency there. People can go and look at those priorities.

Senator DI NATALE: They're pretty broad. There's a lot of discretion for the minister to decide what to fund in what areas.

Dr Hartland : What to fund is a different question. All of the programs have a separate process around selecting individual grant recipients.

Senator DI NATALE: But the dollars are what determine the priorities ultimately. You can have a broad set of priorities, but if you put a hell of a lot of money into one area that becomes the priority, doesn't it?

Dr Hartland : Yes, that's right.

Senator DI NATALE: And, ultimately, that's a decision for the minister?

Dr Hartland : For the minister—well, the minister needs to go to cabinet.

Senator DI NATALE: For the government of the day?

Dr Hartland : That's right, yes.

Senator DI NATALE: Again, we should be trying to create an evidence based framework where investment dollars are being allocated according to need, not according to, as I say, the minister of the day's—some people will call them priorities; other people might call them pet projects, and other people might call them election opportunities, depending on what perspective you're coming from. But shouldn't it be coming from the bottom up in the way that the NHMRC does their work?

Ms Kneipp : NHMRC can speak for itself, but historically there's been a lot of investigator-driven research. Correct?

Senator DI NATALE: Yes.

Ms Kneipp : MRFF is priority setting research. The act requires the board to consult with the community and the sector about the priorities, which makes the priorities a document that the community owns, that the government considers when making decisions. The issue that I think you're trying to articulate just emphasises the importance of the sector and the community getting engaged in the board's consultation process, which is a message we've been spruiking a lot.

Senator DI NATALE: I think that's important, but I suppose the concern I've got is how that actually translates to where the money flows and how that reflects all of the priorities that are agreed upon. Ultimately, again, it becomes a question for government, the minister of the day, to decide where to allocate the bulk of that funding.

Ms Beauchamp : It might be worthwhile us putting together how all of the different elements fit together with the MRFF, the NHMRC and the BTF. I think it's a combination of investigator-driven processes, but also the government identifying where the gaps are, particularly translation research. The MRFF has been used a lot for the translation research and identifying those gaps. It's probably more than just communication—I agree—and perhaps we need to look at how we map and how we engage researchers, because a minister doesn't make these decisions alone; he actually does consult with key stakeholders and particularly the advisory board. So, we might put something together that shows how all these bits fit together.

Senator DI NATALE: We're into the third year now?

Ms Kneipp : The second year of disbursements.

Senator DI NATALE: The second year of disbursements and the third year of the fund. This is the second year that money has flowed—but the fund was established before that—and we're still having this feedback from the research community: 'We actually don't know how the decisions are being made.' That's a problem.

Ms Beauchamp : If that's coming from some elements then—

Senator DI NATALE: I think it's already been acknowledged by the department that that's an issue.

Ms Beauchamp : perhaps it's up to us to articulate better how the various elements of government's research effort fit together.

Ms Edwards : We also note that many of the researchers that we deal with are very excited and enthused by this particularly huge investment. The fact that the government has made such a long-term clear commitment in genomics, for example, in mental health and so on, really gives guidance on where that money is going to be available long-term for researchers to do key priorities. There is obviously more work for us to do in terms of how we administer the project. But it is something that I think has really excited and enthused a lot of researchers, and we are aiming to consolidate on that as we roll out the programs.

Senator DI NATALE: How much of the funding has gone towards prevention or chronic disease?

Ms Kneipp : In the first disbursements, $10 million went towards The Australian Prevention Partnership Centre, or TAPPC.

Senator DI NATALE: And what proportion of the total disbursement is that?

Ms Kneipp : That was $10 million out of $60 million from the first year of disbursements.

Senator DI NATALE: Okay, that was from the first year. I am talking about the most recent budget round.

Ms Kneipp : It is difficult to quarantine prevention research, but there are a number of programs in this year's disbursement that would cut into that place. That obviously includes mental health research, which is often focused on prevention. Keeping Australians out of Hospital—that program is focused on prevention. Maternal Health in the First 2,000 days is definitely prevention. The Advanced Health Research and Translation Centres and the Centres for Innovation in Regional Health are very focused on rapid applied translation across the system, including primary care and hospitals. So some of their projects touch on that space as well. Then there is the accelerator that we mentioned looking at heart disease and diabetes. Obviously that might have some prevention elements.

Senator DI NATALE: When you look at what is clearly labelled as prevention—and I agree that where you draw those boundaries can be tricky—it is broadly about one per cent of total disbursements. I am wondering how that fits in with the priorities that have been established.

Ms Kneipp : Prevention is identified in the priorities. We can take that on notice. You can create the program and go to market and call for it. It is the researchers' ideas around solutions to the problem that will show you where on that care continuum there effort is going to lie.

Senator DI NATALE: Given that it is a priority, if it is only one per cent you would hope to be increasing the proportion of funding for prevention activities over time.

Ms Kneipp : Yes.

Ms Edwards : I don't think our calculation would have it as one per cent. We might have to come back to you another time.

Senator DI NATALE: On notice—that would be great.

Ms Kneipp : With caveats.

Senator DI NATALE: That's fine. I'm talking about clearly prevention labelled activities, but you may have a different—

Ms Edwards : It is certainly a much higher percentage when you consider the things being worked through with some of the major projects.

Senator DI NATALE: Maybe you could provide that on notice. That would be great.

CHAIR: I think we have a couple of senators with questions regarding the NHMRC. Senator Steele-John, do you want to kick off?

Senator STEELE-JOHN: Yes. I would like to ask some questions on behalf of the between 94,000 and 240,000 Australians who journey with ME/CFS. I would like to specifically ask questions around the advisory committee which exists within the NHMRC in relation to this issue. First of all, how did you select the scientific and research members of the advisory panel?

Prof. Kelso : Thank you for the question. As you would probably know, we have been interested for several years in developing some kind of response to the very difficult issue of ME/CFS. We have formed an expert committee which is made up of people with a particular interest in this sort of issue and with the type of clinical and biomedical skills that are necessary to understand the type of clinical situation, as well as representatives of patient organisations with a particular interest in ME/CFS.

Senator STEELE-JOHN: Fantastic. Take me through the selection process. Was there a call-out? How did you go about soliciting the members of this committee and then sifting through to select the ones that you wanted?

Prof. Kelso : As is usually the case with committees like this, we seek advice on appropriate expertise. Rather than calling for nominations, we seek advice and form a committee which attempts to balance a broad range of expertise and types of research as well as the consumer understanding and involvement.

Senator STEELE-JOHN: Do you have a formula which gives a certain weighting to expertise over consumer experience, say?

Prof. Kelso : No, it's not a particular weighting. It would be normal for us to have at least one consumer representative. We have three on this committee, which reflects the fact that there are two different groups. There is Emerge Australia and there is ME/CFS Australia, so we have three members of the committee out of approximately 12, I think, who have direct experience with ME/CFS.

Senator STEELE-JOHN: According to the relevant section on your website, you do a lot of work to look at perceived or real conflicts of interest in the selection of committee members as well. Could I just ask you whether you would agree that it would be concerning if a member of the panel thought that ME or CFS patients could be cured by doing things like aqua aerobics?

Prof. Kelso : In considering conflicts of interest, we consider the particular expertise and whether there's any kind of financial linkage to a group which would be inappropriate. If somebody has expressed views about a particular treatment, in this case, then what would be most important is that the committee knows that those views have been expressed so that other members can take that into account in considering the input of that person. That person may have a range of skills and expertise which extend well beyond that particular point and may be valuable for the committee for that reason. The most important thing is to have everything out on the table, and then a decision is made about whether that's something that means the person should be excluded from the committee or whether their advice as a member of the committee should be moderated, if you like, by knowing that they have a particular viewpoint.

Senator STEELE-JOHN: Is it your understanding that this particular committee has been through that process?

Prof. Kelso : Yes, it is. And it's a standard process for all of our committees, of which we have many.

Senator STEELE-JOHN: You'd be aware, Professor Kelso, that there's a discourse around the psychological aspects and physical aspects of curing these kinds of things which is a particularly concerning line of questioning for many people who journey with this condition?

Prof. Kelso : I am aware that it's a controversial topic and that there are different views expressed about the contribution of different components, if you like, or different possible contributors to the symptoms. But this committee is working from the starting point that this is a real issue—it's a real clinical issue that needs to be taken seriously. Its purpose is to provide advice to NHMRC about how we can best support research or guidelines or whatever is the most useful way that we can contribute to addressing this problem in a realistic way in the community.

Senator STEELE-JOHN: Fantastic. That is wonderful to hear. I think the committee last met on 18 March. Is that correct?

Prof. Kelso : It has met recently, and I believe its next meeting is today.

Senator STEELE-JOHN: Well, that is fantastic to hear. Is it possible to provide the committee with a copy of the agenda for today's meeting, or is that published post the meeting?

Prof. Kelso : Our normal process is to update our website after each meeting. We have a particular page for this committee because we know that there's a lot of interest in the wider community. Our normal process would be to update that web page, after the committee has met, with any further progress that has been made.

Senator STEELE-JOHN: Wonderful. Are those meetings open to the public? What's the process? Can you view them anywhere, or are they held in private?

Prof. Kelso : They are closed meetings. But the intention is that the committee will draft a report later this year, and that report will be used as the basis for public consultation before they finalise their advice to me as the CEO of NHMRC.

Senator STEELE-JOHN: Is there a rough time line for the release of that report?

Prof. Kelso : My notes simply say that the report will be drafted later this year, and of course that depends on the committee reaching a point where they are ready to draft that report. We haven't imposed a deadline on them. We know that there have been very detailed and intensive discussions so far. That will determine whether they need to meet more times and how much work needs to be done before the draft report is released for consultation.

Senator STEELE-JOHN: Just finally, I'm wondering whether you'd be able to give an update on the NHMRC's targeted call for ME and CFS research and what discipline or field of study the proposal you are considering would explore if successful.

Prof. Kelso : At this stage, we haven't made a decision to hold a targeted call for research, because it will depend on the advice from this committee. This committee is tasked with giving us advice on the best way we can support research or other needs that are appropriate for NHMRC to contribute for this disease. So it may not be a targeted call for research, but it's equally possible that it will be. Then we'll await their advice, if it is a targeted call, on what the scope of that call would be.

Senator STEELE-JOHN: Thank you for your time, Professor Kelso.

Prof. Kelso : Thank you.

CHAIR: I believe that is all for this outcome. Are there any other senators with questions on program 1.1 to declare?

Senator GRIFF: You've covered the majority. Perhaps, Professor Kelso, I could ask just a couple of brief questions. Do you ever actually go out and seek public expressions of interest for people who may want to be in these committees? I think you said that it's more or less worked out internally with experts that you deal with. Is there ever any time where you might go out there and say, 'We're seeking involvement on an advisory committee'? That to me would seem to be a worthwhile exercise for you to determine who else out there may be prepared to get involved who might have a high degree of expertise as well.

Prof. Kelso : We certainly do that for council and principal committees. There's a call for people to self-nominate or to nominate other people to be on the Council of NHMRC or the Research Committee or the Australian Health Ethics Committee—the several principal committees that we have. It's not normal process for the other committees which are specifically advisory to me and are not already specified in our legislation. But it is a possibility in some cases, and I'm wondering whether we have ever done it for a particular disease area. It's certainly worth us considering in cases like this.

Senator GRIFF: My understanding is that your previous committee had 14 advisory members—this was the one back in 2002—and two conveners, and the current one has six members. Is that correct?

Prof. Kelso : I'm sorry; which committee?

Senator GRIFF: The CFS committee that operated in 2002 actually had 14 advisory members.

Prof. Kelso : That's a long time before my time. I don't know if there's anybody in the team here who was around in 2002.

Senator GRIFF: You can't channel a previous—

Prof. Kelso : No.

Senator GRIFF: I can't pull it up right now, but I do have it here. This related to the guidelines that were written in 2002. There were 14 members of the committee at that time. Now, given the importance of having members with biomarker and molecular expertise—and I believe there are only a limited number of people on the current committee who have that, perhaps only one person, in my understanding—would you consider adding more members with biomarker and molecular expertise?

Prof. Kelso : We might need to take the question on notice to be certain exactly who has that sort of experience. But I can see at least one person there who I know for sure has that kind of background.

Senator GRIFF: My understanding is that there is one. But, for instance, in the US equivalent committee, all members have biomarker expertise, because, as you've indicated, it's very different now than it was, going back 10 or more years ago.

Prof. Kelso : Yes. I think that our committee composition reflects a broad view about the type of advice we might receive. Particularly there's an interest in immune biomarkers at the moment as a very fruitful area of research for a potential diagnostic for ME/CFS. That is one area where we would want to have expertise on the committee. But it's not the only area, so I think we have a broad range of clinical expertise here, including infectious disease, if I'm correct—sorry, I'm flipping through here. I think we have at least two people on the committee, one of whom is directly associated with the biomarker work at Griffith University; the other has a long-term interest in the relationship between virus infections and chronic fatigue syndromes and is a clinical immunologist and would have a very good understanding of this area. So from my knowledge, just looking quickly at the members of this committee, we have at least two who have direct expertise or the broad expertise that would be necessary to—

Senator GRIFF: And some of them would have expertise on markers for poor mitochondrial function as well?

Prof. Kelso : Mitochondrial function!

Senator GRIFF: I learnt so much when we caught up a few weeks ago!

Prof. Kelso : Yes, it's our other area of common interest at the moment. I'm not sure exactly about mitochondrial genetics expertise. That's an interesting question. I'm not aware of whether that has been identified as particularly important for ME/CFS, but I can find out about that.

Senator GRIFF: I understand that it is related to poor mitochondrial function, so I would have thought that it would have been important to have that level of expertise on the committee as well.

Prof. Kelso : Perhaps I could just add, then, that the importance of this committee is not necessarily to have a deep understanding of all of the possible mechanisms that lead to ME/CFS but to be able to give us the type of advice on what the best way we could invest in this area would be, whether it's through a targeted call for research or it's through the need for clinical guidelines. Sometimes what one then needs is a range of expertise that extends beyond the specific biology of a syndrome. So I believe we have a good mix there, but we could provide more information, Senator.

Senator GRIFF: Yes, if you could, thank you.

Prof. Kelso : Thank you.

CHAIR: Just a really quick one from me before I let you go, linking back to what department officials said earlier about the genomics mission: how does the NHMRC interact with something like that? Obviously the minister, the government, sets the priority agenda. We've got this focus. How does the NHMRC interact with that focus?

Prof. Kelso : First of all, the NHMRC has funded a lot of research in genomics over the last few years, so, in a way, NHMRC has been supporting the foundations on which this mission will be built. In particular, our two largest-ever grants have been in the area of genomics. One was a $27.5 million grant from 2009 to 2014, which was for international projects on ovarian cancer and pancreatic cancer sequencing. Then the second one—which is really very relevant to the mission—was the targeted call for research on preparing Australia for the genomics revolution in health care. That is a national network of about 80 chief investigators led by Professor Kathryn North, who's the Director of the Murdoch Children's Research Institute. That has really established a national network, which I think by its very nature, in the work that it's doing, is the foundation on which the mission can be built. So we already have a strong interest and investment in the area.

Then it'll be up to the department and the further development of the mission, under the guidance of the advisory committee which has just been announced, to determine whether NHMRC would be directly involved in any schemes that might be rolled out under that mission. That's something that will be open to the government to use if they wish, but only if that fits in with the plan for the mission and whether it's useful to use our services, if you like.

CHAIR: I'm happy for you to take this one on notice. Does a body like the NHMRC, or another body, track, for example, the cost of gene sequencing over time? My understanding, anecdotally, is that the cost has come down massively. But does anyone actually keep an eye on that?

Prof. Kelso : I have—perhaps like you—seen many articles and heard many talks where people have shown these extraordinarily impressive graphs showing how the cost of sequencing one human genome has dropped from $3 billion—which is what the first human genome sequence cost—down to something that's approaching $1,000 today, so that it can now be considered as a support for clinical decision-making. I don't think it's difficult to find the data to support that, particularly because the starting cost of the Human Genome Project was about $3 billion. So that's basically true, I think; it's a massive drop.

CHAIR: Is NHMRC investing in any projects to try and drive down those costs even further? Is that a particular area of research? Or has that just happened in conjunction with other research efforts?

Prof. Kelso : It happened partly because the industry which produces the machines which are used for genome sequencing has invested very heavily in the development of new technologies. Often the ideas for new technologies for gene sequencing will come from the research sector—universities and institutes—and that's been happening around the world. Then companies will run with a technology to produce their latest set of machines that they'll sell, to hospitals or universities, to undertake genome sequencing. I'm not aware whether any Australian researchers have contributed directly to the improvement in the technologies that have led to that drop in costs. But it has, indeed, been an international effort.

CHAIR: Okay. So I think we can dispense with program 1.1 now. We'll move on to program 1.2, Health innovation and technology. Senator Watt has the call.

Senator WATT: Thanks, Chair. I have some questions about the My Health Record. How many Australians have a My Health Record as of today?

Mr Kelsey : The answer is 5.8 million.

Senator WATT: And—forgive my ignorance—the My Health Record is intended to apply to all Australians, not only people over a certain age. It's 5.8 million of the total Australian population? Are you still on track for every Australian who doesn't opt out of this scheme to have a My Health Record by the end of the year?

Mr Kelsey : Yes.

Senator WATT: You are?

Mr Kelsey : Yes.

CHAIR: Sorry, Senator Watt, can I ask a follow-up question on your first question?

Senator WATT: Yes.

CHAIR: Is there any skewing in the age range? Is it skewed young?

Senator WATT: Do you mean of the 5.8 million who already have them?

Mr Kelsey : Yes, it is. I might ask my colleague Mr O'Connor to come in—but, from memory, 39 per cent are under the age of 18.

Unidentified speaker: Yes.

CHAIR: Perhaps on notice, could you provide us with an age breakdown? That would be great. Thank you, Senator Watt.

Senator WATT: I'm going to take a punt that the proportion of the Australian population under 18 overall is not 39 per cent, so it's disproportionately weighted towards younger people?

Mr O'Connor : The demographic breakdown is: 54 per cent female, 46 per cent male; 36 per cent are 19 years of age or under; 25 per cent are between 20 and 35 years of age; 25 per cent are between 40 and 64 years of age; and 14 per cent are aged 65 plus.

Senator WATT: Thanks. You said you're still on track for every Australian who doesn't opt out to have a My Health Record by the end of the year. How many people in total do we expect to have a My Health Record by the end of the year? I'm presuming it's the entire Australian population?

Mr Kelsey : It's the entire Australian population and those who are resident in Australia and therefore are eligible for either a Medicare card or for a veterans' card.

Senator WATT: Do you have a number for how many that is?

Mr O'Connor : The number at the moment—which we'd need to check—is approximately 25 million.

Senator WATT: Yes, I was thinking it would have to be around about that. So about a quarter have currently got one?

Mr O'Connor : Correct.

Mr Kelsey : Yes, that's correct.

Senator WATT: You've got nearly 20 million to go between now and the end of the year. What systems do you have in place to deal with that? That's going to be a pretty massive influx.

Mr Kelsey : Yes, in terms of the technological systems. The program has been running since 2012, and it has been running on the same infrastructure since that point, as it will during the course of the opt-out period and beyond. We have great confidence in the platform on which it's running, which has been tested at that kind of industrial strength. As you'd expect, we have run a series of tests to more than exceed even imaginable levels of demand for the service to ensure there's no risk of any technology failure in relation to the core database.

Senator WATT: In terms of the opt-out communication campaign that's occurring, you've announced that the three-month opt-out period begins in July. That means that, yes, there's a three-month period in which people who want to opt out of having this My Health Record have the opportunity to do so?

Mr Kelsey : Correct.

Senator WATT: That's a three-month starting in July?

Mr Kelsey : Yes.

Senator WATT: Is there a public information campaign underway or planned to inform Australians of that right?

Mr Kelsey : Yes. There is a very comprehensive communications plan that was informed in its design by the experience of two opt-out trial site pilots that were run by the Department of Health in 2016, and the communications exercise will deliver, to all Australians, the opportunity to be aware of their rights to opt out and, if they wish to, to opt out. We can give you all the details of that campaign if you'd like.

Senator WATT: Yes. That would be good.

Mr O'Connor : The campaign itself is very much delivered through some of our partners. So we have contracted with 31 Primary Health Networks to conduct community engagement activities throughout that three-month window. One of the key learners from the trial sites was not to start that communications campaign too early. So we will launch that campaign on 16 July. Within the PHN remit, we've contracted them to deliver over 1,000 events throughout that three-month period, and that will happen right across the country.

In addition to that, information will be made available in over 15,000 healthcare locations, including every GP practice, community pharmacies, and public and private hospitals. We've also worked with Aboriginal health services and their organisations to ensure that the communications are in those environments as well. We've also contracted with other organisations, including Australia Post, whereby there will be information in 3,600 Australia Post outlets that will reach over two million Australians throughout the three-month period. We've also worked with the Department of Human Services, so we will ensure that all their access points have the relevant information and the services there provide 80,000 contacts a day. We've also arranged that it will go out with any communication from DHS throughout that three-month period—there will be information within letters that will go to 3.2 million people. There will also be information on the DHS website and Medicare online. I've got quite a lot of detail.

Senator WATT: Is there any media campaign intended?

Mr O'Connor : Yes. This will be supplemented by targeted media activities which will be delivered at a regional and local level. We will work through five PHNs in particular to deliver that campaign so that those processes are in place. In addition to that, we're also advertising within other trade magazines, like Australian Doctor. Similarly, we have put in place arrangements with the pharmaceutical organisations, in particular, and Chemist Warehouse and Terry White Pharmacies, whereby there will be information going out through 20 million copies of their magazines. In addition to that, we've put in place arrangements with peak consumer organisations; there are formal agreements in place there. Some of those organisations are the Consumers Health Forum of Australia, Carers Australia, Australian Council of Social Service, Arthritis Australia, Asthma Australia. I could go on; there's quite a comprehensive list there.

Senator WATT: Is the media campaign going to involve TV, radio and social media?

Mr Kelsey : Contrary to some of the press reports that you will have seen recently, there is going to be paid media for My Health Record. The essence of this program was designed to sustain the context of the opt-out pilots. There's a publicly available evaluation which very clearly says that want people want with this rather complex message around opt-out is to be able to talk to a care professional in the first instance and otherwise to a trusted advocate in their community network. That has been the focus of the work we've been doing. But, to complement that, yes, we are doing paid media, and we will actually, in certain circumstances, also be doing paid television advertising, particularly for Aboriginal and Torres Strait Islander communities. We will be using national television to do that. But, generally speaking, the research has indicated to us very clearly that there are other, more effective approaches to ensuring people are really aware of their rights than national television. But we will be doing radio and we will be doing paid newspaper advertising. Because of the absence, in a way, of national platforms, those adverts will appear through regional and/or local media.

Senator WATT: Okay. What's the anticipated cost of the information campaign overall?

Mr Kelsey : The total budget is $25 million?

Mr O'Connor : Yes, the total budget for the communications is $27.75 million. We have already said that a key component of that is in relation to providing education, support, training and information to providers, and we're writing to every single provider across the country and providing training to those as well. There is a budget there allocating $55 million.

Senator WATT: Is that in addition?

Mr O'Connor : That's in addition. And in addition to that as well, one of the key learnings from the trial sites was around the contact centre, so we're enhancing our services around the contact centre. We have put in place an additional 23 specialised services to support hard-to-reach and hard-to-service communities, and within that there's a budget of $34 million, which also includes the technical side of the opt-out portal for consumers to opt out.

Senator WATT: What was the $27.75 million for?

Mr Kelsey : Public communications.

Senator WATT: Is the paid media aspect of the campaign contained within that 27.75?

Mr Kelsey : Yes. That's $4.8 million.

Senator WATT: So, all up, we're talking over $100 million for this public information campaign?

Mr Kelsey : And associated activities to, for example, ensure that care professionals are able to—

Senator WATT: Sure. Yes, I'm not suggesting—

Mr Kelsey : Yes.

Senator WATT: And you're confident that that's going to reach every Australian?

Mr Kelsey : I'm confident that we've done everything we can to ensure that every Australian has the opportunity to learn about the My Health Record and their right to opt out, and we are monitoring the degree to which awareness follows that opportunity. We will intervene if there are communities that seem to have less awareness than others as we go through the opt-out period. But I should also stress that, if for some reason somebody is not aware of their rights to opt out during the opt-out period, they can cancel their My Health Record subsequent to the opt-out period at any time.

Senator WATT: That was going to be one of my later questions, actually. So you can opt out after the expiration of that three-month period?

Mr Kelsey : You can cancel your record.

Senator WATT: Got it.

Senator DI NATALE: Can I follow up? What does cancelling your record practically mean?

Mr Kelsey : What it practically means is that, when opt out occurs, if you haven't opted out—and I should also say for clarity that there is a three-month period during which people can exercise their right to opt out—there will then be a month during which we reconcile paper forms, and we're providing paper forms to those who, for example, don't have access to the internet or don't wish to, and at that point, records are created. What that means then is that you will have, as it were, an account, but no data will be in it. In order for that account to start being populated with health information, either there will be an episode of clinical care or you yourself will activate the account as you wish. From that point onwards, data according to your engagement clinical services or your willingness to upload information yourself will then populate. So, in the event of cancellation after opt out, if you have any data in your record—and people may not, because they may not have had an encounter with a health provider or have chosen to activate it themselves—

Senator DI NATALE: Do you mind if we prosecute this here?

Senator WATT: No.

Senator DI NATALE: So, practically, you've got this three-month window where you can opt out. Let's say you miss the window and two months later you think: 'Hang on. I forgot to do that thing I was supposed to do.' Will any data be downloaded into your account? I understood that NDS and PBS data would be.

Mr Kelsey : Not unless the account's been activated, and the only way in which the account can be activated is by yourself or by you having a clinical interaction if you haven't opted out.

Senator DI NATALE: So you could get hit by a train and end up in an emergency department and you haven't opted out. What will then be activated—two years of MBS and PBS data? Is that correct?

Mr Kelsey : That's one of the reasons why opt-out is so strongly supported by the clinical community or clinical leadership—for exactly that scenario. In emergency medicine, it would mean that you wouldn't have had to do anything, but your physician would be able to upload a discharge summary into the—

Senator DI NATALE: I understand that. I'm getting to the point of somebody who doesn't want this, for whatever reason, ending up having a clinical encounter where they haven't got the capacity to say: 'Actually I wanted to cancel this. I don't want you to have access to my information.' If that clinical encounter is somebody in, as I say, a hospital setting, what would automatically occur at that point?

Mr Kelsey : At the point at which the emergency physician or whoever would upload the discharge summary to My Health Record, that would activate the account. At that point, two years worth of MBS and PBS data would start to be uploaded. At any point, what's called the recipient of the record, or the health consumer, can switch off that feed of MBS and PBS data if they choose to, in order to keep their My Health Record alive, as it were. One of the things that it's really important to recognise is that, even after opt-out, for every document type you can withdraw your consent from that document being uploaded to My Health Record, which includes MBS and PBS data.

Senator DI NATALE: And you can retrospectively wipe all that information?

Mr Kelsey : Yes, correct.

Senator DEAN SMITH: I want to go to some comments you made in your address to the National Press Club. In that you talked about the framework around secondary use. Can you just explain that to us? I'm particularly interested also in your comment about ensuring that every person would be able to choose whether or not they wanted their information used for secondary-use purposes. I'm keen to know how the consumer maintains authority over that. In particular, I'm also keen to understand what authorities might be able to override a consumer's desire to have their information not used for a secondary purpose, or secondary use, as you call it.

Mr Kelsey : The framework, of course, is the responsibility of the Department of Health, so I perhaps can hand over to the secretary.

Ms Edwards : I might start the answer. The secondary-use framework obviously is designed to govern the circumstances where all of the data contained in My Health Record, which accumulates over time, could be de-identified and then used for important research purposes. That's something that's heavily supported as a real key source of incredible data, but we need to be very careful—

Senator DEAN SMITH: Research purposes for medical research?

Ms Edwards : Medical research. The framework sets out the basis on which that might be accessed in the future, once there is data. We don't think that's going to happen very soon. Obviously it'll take a while for My Health Records to be created and populated, so there's time for us to make sure we've got the systems in place. But it's very important to release the framework in advance of the opt-out period, which happened on 11 May. The headline items in that are: the data custodian will be the Australian Institute of Health and Welfare, a very reputable, independent organisation to be custodian of the data; data will be able to be released for public health and research purposes only and under no circumstances for solely commercial purposes: there will be no release to insurance companies—

Senator DEAN SMITH: 'Solely commercial'—so it could be jointly commercial?

Ms Edwards : Potentially, but certainly not to an insurance company for any purpose such as use by an insurance company. It's got to be for health and research.

Senator GRIFF: So drug companies would be acceptable?

Ms Edwards : A drug company which is getting the data for the purpose of research which is going to, for example, create a life-saving medicine might be acceptable, but it has to be for that purpose. It is important to say that there will be linkage available to other data, potentially through AIHW, but only the de-identified final product data would be released. Those are the key headline items in the framework, and there's a very complex governance structure being set up, led by the AIHW, to make sure that the framework is adhered to and that privacy is paramount in the use of this very rich data source for the benefit of Australians going forward.

Senator DEAN SMITH: Where does the authority sit to release the data? Who makes that decision and what's the governance that sits around that decision-making process?

Ms Edwards : I might refer you to the framework.

Senator DEAN SMITH: I can have a look at the framework after—

Ms Edwards : Obviously it will be much better than me in terms of summarising it.

Senator GRIFF: Ms Edwards, while you're looking at that, if you've got a record, are you able to say you don't want it to be used for secondary purposes, for instance?

Ms Edwards : Yes. Mr Kelsey might be able to explain the details, but before the opt-out period you will be able to say no to secondary use of data.

Mr Kelsey : Just to explain, amongst the privacy controls within the My Health Record, there will be a new privacy control added which allows you to express a preference to withhold your consent for data being used for any secondary use at all. That will be available to people with a My Health Record from the beginning of the communications exercise around the opt-out period. So it will be available in the next couple of months, even though, as my colleague says, data won't flow for some time.

CHAIR: Can I jump in there? How many people have exercised their right to alter their settings in that way? Do we know?

Mr Kelsey : The functionality hasn't yet been released into My Health Record because we were awaiting for the framework to be published.

Senator WATT: Aside from, essentially—

Senator DEAN SMITH: Don't get too far ahead, because I am still interested in my question. Who makes the decision? Is the decision disclosed to the broader community? I'm interested in the governance that sits around that.

Ms Edwards : The final decision will rest with the data governance board which will be established with the AIHW.

Senator DEAN SMITH: Is it a subset of the AIHW board, or are they one of the same thing?

Ms Edwards : I might have to take the detail of how it operates on notice.

Senator DEAN SMITH: How is the board appointed?

Ms Edwards : It will be comprised of representatives from the AIHW, from the agency and a range of independent experts, including from population health, epidemiology, research, health services delivery, technology, data science, data governance and privacy and consumer advocacy. The board will oversee the development and operation of all secondary use information.

Senator DEAN SMITH: When the board makes a decision to release the data for research purposes, will that be publicly disclosable? Is there a public reporting mechanism there?

Ms Beauchamp : I think there are a number of processes to go through first. Data will not immediately flow from My Health Record to the AIHW. I think the AIHW ethics committee will first consult with stakeholders on the planned ethics and approvals process, particularly to ensure the protection of individual privacy. Then the use, in terms of the framework, will be governed by the board, and the board will release regular statements about data availability and quality. So it will be fairly transparent. But I think there are a few processes to go through beforehand to make sure that we get it right and protect the privacy interests of individuals.

Ms Edwards : I hesitate in answering the question in detail. It's obviously for the AIHW to establish the board and set its processes. Definitely the case is that it will be a transparent and appropriate public process.

Senator DEAN SMITH: That's all for the moment from me.

CHAIR: We do have more questions in this area, so we are going to have to come back after lunch. We will call a halt. We'll suspend a couple of minutes early and we will resume at 2 pm.

Proceedings suspended from 12 : 58 to 14 : 00

CHAIR: We will resume with the Health Portfolio. We are in program 1.2: Health, Innovation and Technology, including the Australian Digital Health Agency.

Senator WATT: Before the break, we were talking about the information campaign that you're going to be running to make people aware of their right to opt out of this health record and it emerged in some of the other questioning that, apart from having the right to opt out altogether, people will have the opportunity to say that they don't want their information used for, I think you said, secondary purposes. And I can't remember whether we ended up getting a full list of the kinds of secondary purposes that will be recognised? I think we talked about for medical research. What are the sorts of categories?

Ms Edwards : That's a matter for the department. The full framework is set out in the second-year's framework, which has been made public and we can table a copy if you would like. I would refer you to that. And, as I mentioned, the data custodians are AHW, so a lot of the processes and so on will be worked out by them as to how the data governance board of AHW will make the decisions. But full information about the framework is available publicly.

Senator WATT: I'll have a look at that then. This might be in the framework as well, but I'm just interested to know, aside from the ability to opt out all together and the ability to effectively opt in by not opting out but saying you don't want it used for secondary purposes, are there any other ways that people can, in some way, limit the use of their health records?

Ms Edwards : This may be something that I have to refer back to the agency. As I understand, at the moment, it's a matter of the functionality to do it, and we're starting out with opt-out completely but, perhaps down the track, we would have. Is that right?

Mr Kelsey : As we discussed before, there is an option to withdraw consent from the use of data for the secondary uses you've discussed. But there is a series of privacy controls in the legislation in relation to its primary use, where you can restrict other people's access to your medical information in the My Health Record. Perhaps I can ask my colleague.

Ms McMahon : There is a range of privacy controls that consumers can exercise. One is controlling which health operators can access any information in the My Health Record, and they can set a record access code on their record and get an SMS alert if someone tries to access that record, and they can provide that access code to a healthcare organisation to provide that access. Beyond that organisational control, a consumer can actually put a mask on particular documents within the My Health Record that they do not want visible to healthcare providers involved in their care and they can do that at any time.

Senator WATT: I imagine it's a bit of a balancing act. You've got to undertake this public information campaign to make people aware of the right to opt out while, at the same time, I presume you are not trying to scare people off; your preference is for them to opt in. Is there any risk that making the opt-out process too prominent could cause people to opt out unduly?

Mr Kelsey : Let me be absolutely clear: the agency, as such, the system operator, has no opinion about the levels of opt out and it's certainly not expressing an opinion about whether an individual should or shouldn't opt out. Our job is to ensure that all Australians have the opportunity to be aware of their rights and to know how to opt out if they choose to.

Senator WATT: How many people have registered to get instructions on the opt-out process to date?

Mr Kelsey : I will just have to get advice on that.

Mr O'Connor : There are just over 11,000.

Senator WATT: I didn't even know that there was such an ability. So, if someone wants to opt out, is there the facility right now to register to find out how they go about doing that?

Mr Kelsey : Yes, and we will email them when the opt-out process is active, which is 16 July.

Senator WATT: That was my next question.

CHAIR: When you say 'register', is that 'I want more information'?

Mr Kelsey : You can go on to our website and you can leave your email address there if you wish to be informed of the moment when the opt-out process is active.

CHAIR: So those people haven't made a decision to opt out; they've made a decision to be kept informed?

Mr Kelsey : Correct.

Senator WATT: Those people have not yet received instructions on how they can opt out?

Mr Kelsey : No.

Senator WATT: That will happen—

Mr Kelsey : On or very close to 16 July.

Senator WATT: I don't think you answered this before the break. What will the opt-out process actually look like?

Mr Kelsey : There are three ways in which people can opt out and, again, they have been designed in the context of the learning from the opt-out trials. The first is online, the second is via the call centre and the third is that, where appropriate, particularly in remote and rural Australia, there will be the opportunity to opt out on paper forms.

Senator WATT: The same form to be completed via whichever of the three mechanisms people use?

Mr Kelsey : Yes.

Senator WATT: Is it a big form or a short form?

Mr Kelsey : It's a very simple process. We've worked very hard to ensure that that is the case. You need some items of identification—a driver's licence, for example, or a passport—to be able to opt out of the My Health Record.

Senator WATT: There's really only one question on the form: do you want to opt out—tick 'yes' or 'no'?

Mr Kelsey : Essentially, yes.

Senator WATT: Has there been any modelling done to establish the number of people that you expect will opt out?

Mr Kelsey : No.

Senator WATT: I think we worked out that there's about 25 million Australians who would be, if you like, eligible for a My Health Record, but we don't really know how many we're expecting to opt out?

Mr Kelsey : No. The basis of this project is to accelerate the clinical benefits that have been identified and associated with the sharing of key information about a person's health. Our objective is to identify and accelerate those benefits. Those benefits are not contingent, really, on the rate of opting out, so there is no notional target rate. The important thing is that we have made every reasonable effort to communicate the rights people have to opt out to the community at large in Australia.

Senator WATT: What proportion of people who participate in the trial sites opted out?

Mr Kelsey : One point nine per cent.

Senator WATT: And how many people participated in those trials?

Mr Kelsey : Around a million.

Senator WATT: Would you expect it to be a fairly similar proportion?

Mr Kelsey : I wouldn't have any opinion.

Senator WATT: I suppose the effectiveness of the record is dependent on the number of people who sign up?

Mr Kelsey : There was one other important component of the government's evidence base around moving to opt-out registration: the results of a very important experiment in the Northern Territory over a number of years in which shared information was made available to clinical practitioners. In that case, after the evaluated review was undertaken, what made clinicians build it into their work flow is that more than 51 per cent of the community had an electronic health record. It's a different circumstance, but that was the tipping point at which the clinical benefit started to accelerate, because GPs and others routinely would look at the record that an individual had.

CHAIR: If I could put it into the frame of vaccinations, you get an individual benefit, but there's also a community benefit: a herd immunity. I would assume that keeping these records would be similar. Obviously, if one person signs up, that person gets an individual benefit, but the more information we have flowing into the system will also be of benefit?

Mr Kelsey : Yes. Certainly that's true for secondary uses and the analytical purposes we talked about externally, but, as far as the primary use goes, which is the purpose of this current opt-out, I think the benefit is that, if you have one, you are likely to be safer in the case of an emergency, for example, than if you don't.

Senator WATT: One point nine per cent of the one million people who participated in the trials is roughly about 20,000 people and at that rate, across the whole population, you'd be talking about 500,000, if it were that rate.

Mr Kelsey : Yes, that sounds about right.

Senator WATT: I think it's been reported that about two-thirds of people in those trial sites didn't know that they'd been given My Health Records. Is that right?

Mr Kelsey : The evaluation report has actually been published. We can provide you with links that contain all those figures. I think that sounds about right. Yes.

Senator WATT: What public information campaign did you undertake within the trial sites before that?

Mr Kelsey : Again, that may be for the department. The Department of Health ran the opt-out trials originally, but I should say that the learning, the evaluation of that communication activity, is the basis upon which we have designed the national approach to ensure that we do achieve total and comprehensive reach in the opportunity to learn about My Health Record and the right to opt out, and significantly raise public awareness also.

Senator WATT: Is there someone from the department who can tell me what public information campaign occurred in the trials?

Ms Edwards : We might have to take that on notice, because it pre-dates the current officers in the roles and it would be more accurate to take on notice the detail of what happened for the trial sites.

Mr Kelsey : But it is in the public domain, Senator.

Senator WATT: How many people in the trial sites told you, after the opt-out period that was provided for, that they didn't actually want a My Health Record?

Mr Kelsey : Well, the 1.9 per cent opted out of having a My Health Record.

Senator WATT: So, you had an opt-out period in the trials?

Mr Kelsey : Yes.

Senator WATT: And 1.9 per cent of people opt out in total. What I'm interested in is how many people chose to opt out after the opt-out period closed off.

Ms McMahon : To cancel their record?

Senator WATT: Yes, I suppose that's the way to put it—to cancel their record.

Mr Kelsey : I actually don't have that to hand.

Ms McMahon : We have had anecdotal feedback from two regions—Nepean Blue Mountains and Far North Queensland—that there's actually been the opposite effect: healthcare providers have had consumers come to them and say that they now want a record, and they have actually chosen to opt in since then.

Senator WATT: They're people who chose to opt out and have then reconsidered?

Ms McMahon : And are now more comfortable, as time has moved on.

Senator WATT: Actually, I was going to ask about that before. For people who do that—let's say for argument's sake that someone opts out and then two years later they decide, 'Oh, actually I do want to have this record after all.' Will they have an up-to-date record? How will that—

Mr Kelsey : Well, the answer is that if you choose to opt out there is no data, obviously. There is no record, so no data flows into it. If subsequently you choose to have a record created, the record will start from that date, with the exception of two years worth of PBS and MBS flowing at that point. So yes, you will lose potential health information during the period of opt-out.

Senator WATT: Yes. So, the data that's accumulated within that, say, two-year period is not stored somewhere only to be loaded in at a later date?

Mr Kelsey : No, and this is a really important point: there is no system in Australia that does that job. People may have the impression that somewhere, somehow, their medical history is indeed being recorded in a way that can later be uploaded into the My Health Record. The point of the My Health Record is that that, unfortunately, does not exist and, as a result, people are presenting into hospital having to remember their histories, having to remember their medicines. Hence My Health Record is being developed to fill that gap. So yes, the answer is that until you have a My Health Record there is no retrospective means by which it can find health information about you.

Senator WATT: And you've taken on notice the number of people who decided to cancel their records after the opt-out period in the trial sites?

Mr Kelsey : We can certainly have a look for that information.

Senator WATT: If you could, that would be great. And what proportion of people in the trial sites set up PIN numbers to control who had access to their personal information?

Ms McMahon : We don't have the breakdown in the trial sites, but less than a 10th of one per cent of people have applied privacy controls within their record. We can see if we can get you a breakdown within those regions. We may not be able to, but if the data is available we'll provide it.

Senator WATT: So, having a PIN is one of several privacy controls that can be—

Ms McMahon : Correct.

Senator WATT: But all up it was less than one 10th of one per cent?

Ms McMahon : Yes.

Senator WATT: Has there been any modelling to predict how many are likely to choose those options in the full rollout?

Mr Kelsey : No.

Senator WATT: But would you expect that it would be a fairly similar percentage?

Mr Kelsey : I wouldn't venture an opinion. The important thing is that we do communicate that those opportunities exist for people, and one of the primary focuses of the improved design of the My Health Record over the last couple of years has been to make sure that that is the case. I don't know whether you've seen it, but the means by which you are made aware of those controls I think is fairly clear, and certainly their exercise is straightforward.

Senator WATT: That's obviously a pretty low proportion—one 10th of one per cent. Do you think that is some indication that people aren't concerned about their privacy? Or does it more indicate that they weren't really engaged with the opt-out process? What do you think?

Mr Kelsey : It's consistent with similar international programs. On the whole, people in the context of, say, the English Summary Care Record system and the My Health Record in Australia are engaging in the initiative in order to make sure that their medical information is available, particularly in emergency circumstances, to a care professional. So, whilst those rights exist, it doesn't surprise me that people on the whole are choosing to not necessarily exercise them.

Ms McMahon : Can I clarify that that proportion applies to the entire five-plus million people who have a My Health Record, not just those who were involved in the opt-out trials.

Senator WATT: I see.

Ms McMahon : So four-plus million people have opted in to have a record created for them.

Senator WATT: Okay, thanks. Have you got any information about the clinical take-up rates of the system?

Mr Kelsey : We do.

Mr O'Connor : In relation to the uptake by provider organisations, as of 29 April there were 11,238 provider organisations registered for My Health Record. This has increased at a rate of approximately 120 each month. The breakdown of that figure is 6,372 general practice organisations, 1,831 retail pharmacies, 802 public hospitals and health service facilities, 183 private hospitals and clinics, 186 aged-care registration service organisations, 48 pathology and diagnostic imaging services, and 1,475 other healthcare provider types.

Senator WATT: Once it's fully rolled out and all Australians, other than those who have opted out, have a My Health Record, will provider organisations—GP services, aged-care homes and others—have to register in order to—

Mr Kelsey : No.

Senator WATT: Can you explain how that works?

Mr Kelsey : It's not compulsory for provider organisations to connect to the My Health Record.

Senator WATT: But, to date, a bit over 11,000 have.

Mr Kelsey : That's correct.

Senator WATT: And you have to connect to the record in order to be able to access the information that's on the record, I presume?

Mr Kelsey : Correct.

Senator WATT: Do you know how many provider organisations haven't connected?

Mr Kelsey : I don't, I'm afraid.

Senator WATT: Is there an information campaign being undertaken to encourage providers to connect?

Mr Kelsey : Yes. One of the key prerequisites for the public information service that is being launched on 16 July was a very significant level of mobilisation with the provider community. With our colleagues in the Primary Health Network, in state and territory governments and in peak bodies—which include the AMA, the Royal Australian College of General Practitioners, the Pharmacy Guild, the PSA, rural and remote specialists, GPs and others—we have undertaken a very comprehensive program of education and awareness with Australian providers so that, by the time we go to public communications, all GPs and pharmacists will have been trained in My Health Record. In many parts of Australia, that's already the case as activity has increased over the last few months. That is so that they are able to understand what My Health Record is and make a decision about whether they wish to connect but, crucially, also support and counsel their patients in the event that they are asked about the opt-out opportunity.

Senator WATT: I saw some media reports last year that said only about 263 specialists had connected to the system. Mr O'Connor, in those figures that you provided me, were specialists picked up in any of the categories you listed?

Mr Kelsey : I think that referred to specialist organisations. So that's not the number of specialists but the number of specialist organisations.

Senator WATT: Do you have the comparable figures now?

Mr Kelsey : For specialist organisations? No.

Senator WATT: Could you take that on notice?

Mr Kelsey : Yes.

Senator WATT: To the extent you can work this out, I'd be interested to know what percentage of the number of specialists overall in Australia that represents.

Mr Kelsey : Yes.

Ms McMahon : I will add that there are many specialists who work in the public and private hospitals who also have access through those systems. So, when we're looking at specialist organisations and those employed in those organisations, it will exclude the many specialists working within hospitals accessing the record.

Senator WATT: By 'specialist organisations' are you talking about some of the colleges?

Mr Kelsey : No, we're talking about specialist organisations outside hospital. Organisations can be large aggregations of different specialists in consulting rooms.

Senator WATT: Sure. Does the system still rely on the uploading of PDF documents?

Mr Kelsey : The vast bulk of data in the My Health Record system comes from the MBS and PBS server systems, which are atomic data. Other forms of data are PDF.

Senator WATT: What sorts of forms of data are PDF?

Mr Kelsey : That might be a shared health summary or a discharge summary from a hospital, a pathology report, a radiology report and so on.

Senator WATT: How many My Health Record holders have been affected by unauthorised access so far?

Mr Kelsey : Well, none have been affected. Sorry, do you mean—

Senator WATT: Do you have any data on the number of incidents of unauthorised access to people's My Health records?

Mr Kelsey : In the year 2016-17, we have reported six instances which required reporting, or we voluntarily reported, to the Information Commissioner. In this year, not yet published, we have reported three instances—and perhaps I can ask my colleague to give you details of those.

Ms McMahon : In year 1, which was last financial year, four of the six instances related to fraudulent Medicare claiming—so someone made a fraudulent claim and, through that process, was able to access the My Health Record. Two related to an administrative error where they were processing a newborn Medicare registration form and it resulted in the incorrect consumer on the Medicare card being linked to that record. In this financial year to date, two incidents related to Medicare fraud and one related to the same administrative error.

Senator WATT: Has anything occurred, particularly since the Medicare fraud incidents, to improve the system to try to prevent that sort of thing happening again? Are there learnings from that that are then—

Mr Kelsey : Yes, we constantly work with our colleagues at the DHS to ensure that they are aware of these incidents and can fix and rectify them as rapidly as possible. But none of them, I should emphasise, have resulted in any clinical harm to anybody.

Senator DEAN SMITH: I have a couple of questions. Of the 1.9 per cent that chose to opt out, what were the reasons or justifications that were given?

Mr Kelsey : Again, that's in the published report. The Department of Health obviously undertook that piece of work and it would be more appropriate for the department to comment. But there were a variety of reasons people gave, which are available in the public document.

Senator DEAN SMITH: Does the department want to comment on that?

Ms Edwards : I'm just pulling up the reference to the public report to refer you to. It's a publicly available independent evaluation report, and I'd recommend you go to it rather than have my memory paraphrasing.

Senator DEAN SMITH: I trust you, Ms Edwards! I trust your paraphrasing.

Ms Edwards : Well, on this occasion, I think I'll refer you back to the report. Again, it's predating my time at the Department of Health. We could provide on notice a summary of what it says or—

Senator DEAN SMITH: Yes. Mr Kelsey, there's a fundamental tension here, isn't there, because one of the measures of success of the e-health record would be the number of e-health records that are active over the medium to longer term. How have you ensured that that goal has been properly balanced against the other goal, of ensuring that consumers have control over their health records? I think 'consumer controlled' was the term that you used in your comments. How have you satisfied yourself that you've struck the right balance there? Privacy considerations are important to Australian consumers. I did just try to have a look at some of the reporting around breaches in regard to privacy around healthcare data more generally, not just in regard to what we heard most recently. But how have you satisfied yourself that you've struck the right balance?

Mr Kelsey : Let me reassure you that the privacy of patients is the paramount obligation we have as system operator. It is the first priority of the act that we are operating. But I would also say that the way that success is measured is not by the number of people who have a My Health Record. In terms of the budget measure that the government announced back in May 2017, the criteria for success is reductions in things like adverse drug events in Australia—which currently run at roughly 230,000 per annum—and things like reduced duplication of diagnostic testing. These are the benefits that were called out in the budget measure which supported the investment in moving My Health Record to opt out. So we're not measuring our success in terms of the number of records created; we are certainly measuring our success in relation to delivering those clinical benefits but also in relation to the effectiveness of the very security controls we run on My Health Record to ensure that people's privacy is protected.

Senator DEAN SMITH: What measurements have you put in place, or are you putting in place, to be able to measure the success—

Mr Kelsey : Those outcomes.

Senator DEAN SMITH: given that people will be moving to these health records sooner. How are you measuring that success?

Mr Kelsey : We have a research program that is run by our chief medical adviser, Professor Meredith Makeham, which has a number of approaches. There are actually five and, if you want more detail, Meredith would, of course, be able to provide that information. But, essentially, they range across looking at behavioural changes, introduced in a scientifically rigorous way in terms of clinical practice, like: does how and when individuals are able to access information about a patient they may not have seen before reduce the number of tests they might order? And it goes through to looking at impacts on Medicare behaviours through analysis of data and so on.

So there are five different approaches, and we have set up a series of research collaborations with universities across Australia and with other partners in clinical practice to ensure that we look at the impact of My Health Record in a very robust and transparent way, but from a number of different angles. So we have a comprehensive approach to research, and that is the basis on which we are evaluating impact.

Senator DEAN SMITH: So that will be established or has been established?

Mr Kelsey : Has been—I mean, yes.

Senator DEAN SMITH: What's the time frame for those research projects?

Mr Kelsey : They deliver at different points on the cycle over time, so there are some short-term outputs which we are expecting later this year.

Ms McMahon : In the next six months we'll get the interim results and early results, but most of the programs run over the next 12 months with options to continue longitudinally.

Senator DEAN SMITH: Great, thank you.

CHAIR: Have stakeholders pretty much universally endorsed this process?

Mr Kelsey : Yes.

CHAIR: So there are no outliers in that respect? The AMA, the royal colleges and the consumer networks have all supported this process?

Mr Kelsey : That's correct, yes. Just to make the point, all the clinical peaks are engaged in promoting awareness and they support the concept of opt out of My Health Record because it will accelerate the clinical benefits that I've described. And those peaks—and I must thank them for their support—include, as you say, the AMA, the college of general practitioners, the College of Rural and Remote Medicine, the Australian Association of Practice Management, the Allied Health Professions Australia group, and the Consumers Health Forum and the Federation of Ethnic Communities' Councils of Australia. We're very indebted to the work that we've done with the National Aboriginal Community Controlled Health Organisation, NACCHO, which has helped us ensure that communications work with Aboriginal and Torres Strait Islander communities are appropriate culturally to those communities, and a variety of others. We have relations with more than 100 national peaks who are supporting the move to opt out. And that reflects, at more local levels, quite literally hundreds of chapters or local organisations affiliated to those national peaks.

CHAIR: Great, thanks. It was important to get that on the record. Senator Griff.

Senator GRIFF: Mr Kelsey, you said 11,238 people had registered?

Mr Kelsey : Providers.

Senator GRIFF: Sorry? That are registered for the system at this stage?

Mr Kelsey : So there are 5.8 million Australians.

Senator GRIFF: No, as in providers.

Mr Kelsey : Providers, yes. Organisations, yes.

Senator GRIFF: Out of that, how many would be medical practitioners per se, like GPs and specialists? You mentioned 6,372 GPs. Do you have a specialist number as well?

Mr Kelsey : I don't think we do. We have the number that was reported earlier by Senator Watt in relation to the number of specialist organisations that are connected.

Senator GRIFF: Do those 11,238 they have functional access, or are they just registered? Are all of those people actively sending you data now?

Mr Kelsey : People obviously send data at different times. They are all capable of sending data.

Ms McMahon : It varies depending on the type of healthcare organisation. For example, we have 1,831 retail pharmacies and community pharmacies connected. Each time they dispense a medicine, a record of that dispensed medicine is automatically sent up. So every single one of those is actively uploading data every day as they dispense medicines to people with a My Health Record. With general practice organisations, there's a type of document called a shared health summary that is curated by a general practitioner, and they curate that record and send it up as often as clinically appropriate. So it's not an automatic process. With hospitals that are connected, as a discharge summary is sent, a copy is also sent to the My Health Record routinely.

Senator GRIFF: How many of those GPs—those 6,372—are actively uploading now?

Mr Kelsey : We don't have the figure with us, but we can provide the figure.

Senator GRIFF: On notice?

Mr Kelsey : Yes.

Senator GRIFF: That would be great.

Ms McMahon : It would be the majority.

Senator GRIFF: It looks like to me like you're going to have a fantastic system with a lot of people registered, because it will be automatic for the majority of them. But, obviously—and this is where your focus is—you will need to make sure as many providers as possible are providing input

Mr Kelsey : Yes, correct.

Senator GRIFF: My understanding is that there are 70,000 medical practitioners, of which 40,000 are GPs and 25,000 are specialists. You've got a long way to go to get all of them actively participating in the system.

Mr Kelsey : Just to clarify: the figure, for example, on GPs is for general practices, not GPs.

Senator GRIFF: Sure.

Mr Kelsey : The vast majority of GPs are connected to the My Health Record.

Senator GRIFF: One thing I've been told is that a big issue is that providers need to have a HPI individual and a HPI organisation and there's a lot of difficulty for them to actually register and to have both of those entered into your system and the process is a bit unorderly.

Mr Kelsey : That's a criticism that's been made for a long time, with some justification. This is the process by which a clinician individually obtains the certification that allows them to use My Health Record and as an organisation. We've been working closely with our colleagues at the DHS, who run that process, and the budget required us to have automated the application process for the individual certification before we start and that it will happen. That will reduce the length of time that it takes for an individual to acquire the current physical certificate, which is usually in the form of a CD-ROM, from days to hours.

Senator GRIFF: That's great. In your National Press Club address last week, which was very impressive—

Mr Kelsey : Thank you.

Senator GRIFF: you mentioned that adverse medical events account for two per cent to three per cent of all hospital admissions. We know that this is particularly an issue for the elderly where there is an issue with longstanding or multiple prescriptions not necessarily being reviewed, leaving them at risk of adverse reactions or taking medications they no longer need. Besides listing medications which have been prescribed and dispensed, how can MHR address this problem?

Mr Kelsey : That's a very good point. I might ask Meredith Makeham, our Chief Medical Adviser, who is a practising GP as well the lead research for the agency, to come to the table. It might be good to get a clinical perspective. That was a comment that was made by a very large number of clinicians in Australia, through their peaks. So last year we introduced another functionality into the My Health Record—MedView. What that does, for the first time, is aggregate all a person's medicines information to one easy view, so that you can instantly see the history of a person's medicines. This is having a positive impact on dealing with exactly the issue you've just raised. Meredith, is there anything that you'd add from a clinical perspective?

Prof. Makeham : I think that's a good summary. The increasing connections of aged-care facilities, in addition to this, is also very important, so that clinicians can have a view of documents that are potentially uploaded through those facilities through My Health Record.

Mr Kelsey : In some parts of Australia that is already happening. I perhaps recommend to you the example of Berrigan, which is a community in the Riverina area of New South Wales, where local clinical action has seen the connection of the aged-care facility, the local hospital, the general practice and the community pharmacy so that they are all able to share information, and, as a result, improve outcomes for their patients. In Berrigan, with a community of 920 people, 60 per cent now have a My Health Record and all people over the age of 75 have expressed an advanced care plan intention in the My Health Record.

Senator GRIFF: I know from personal experience that GPs don't always go back and reassess whether longstanding prescriptions are still needed, particularly for elderly patients. Is there, or will there be, a capability for MHR to alert GPs that it's time to review a particular prescription after a period of time, for instance, or alert them to any combinations that might cause adverse reactions?

Prof. Makeham : Currently there's no facility within My Health Record to provide alerts of that nature, but it's certainly an improvement that's under consideration and has been suggested by the clinical community.

Senator GRIFF: That's good to hear.

Ms McMahon : Most healthcare providers access My Health Record data through their own clinical information system that's provided by the software industry. Often the clinical decision support, which is the type of function you're describing, is provided in that layer of the software, so often those software packages will provide alerts, reminders and other assistance to general practitioners or others using the data from the My Health Record.

Senator GRIFF: The reason I ask this question is a personal one. I had an experience with a family member 18 months ago where they were hospitalised. They had been with the same doctor for many years and had been popping literally 50 pills every day. When they were admitted into hospital it was a long weekend and they couldn't contact the doctor, so they had no information whatsoever. She was very sick and so they started afresh at the beginning, and that gave this person an extra two years worth of life. They improved dramatically, because they weren't on this big bundle of 50 drugs that they'd been given for the last 20 or 30 years. I think it would be an interesting enhancement or step to have a look at, when someone has been prescribed certain drugs for a long period of time, to then have that kind of review to happen via the system. It'd be good to hear that it's something that could happen in the system down the track. If overseas researchers apply to use the data, how will you ensure adherence to privacy laws and ensure that they won't reidentify the data in any form?

Mr Kelsey : Could I refer that back to my colleagues in the department?

Ms Edwards : Any release of data would be dealt with under the secondary use framework we were discussing, which will be managed by the AIHW. No data would be released that doesn't comply with the law—privacy and all other laws. Data will be deidentified in very sophisticated ways. There is some small prospect for identified data, but that's only with specific consent of the individual concerned. By far, the most we're anticipating is that it'll be required to be deidentified data. The AIHW and all the experts it consults in the context of its data governance board will ensure that the utmost efforts are made to ensure that it's encrypted in an absolutely fail-safe way. That's really at the heart of what's in the secondary use framework: we should be making available deidentified useful data to help the community and researchers, but in a way that absolutely protects the privacy of any particular clinical records.

Senator GRIFF: Mr Kelsey, in your presentation the other day you stated that MHR is a fully consent based system and that sensitive records can't be uploaded by a doctor without a person's permission. Does that mean a GP or specialist will have to seek a person's permission each and every time a sensitive document or test is uploaded?

Mr Kelsey : No. My Health Record is based on the concept of standing consent. Individuals have the right to withdraw their consent, for example from the upload of a pathology report or a radiology report or any document. Once they have a My Health Record, it's presumed that they are giving their consent unless they choose not to.

Senator GRIFF: Is that even for something that's sensitive or that your classifying as a sensitive document? It doesn't matter what kind of document it is; that permission is there automatically.

Mr Kelsey : In some parts of Australia different states and territories have different approaches as to what is permissible, in relation to the upload of sensitive pathology reports, for example. There are existing policies which the My Health Record merely reflects, so there is already a layer of jurisdictional policy in relation to the upload of sensitive data. Beyond that point, content will be uploaded into the My Health Record where currently somebody has opted in to having one, and in future where they’ve opted out, unless they withdraw their consent from those records being updated. My hope would be that My Health Record as a whole should be a complement to the information resources available to a GP. Remember that most of its records are copies of all the clinical documents—they're copies of documents.

A very important part of the responsibility of a caregiver is that they do counsel their patients on the management of sensitive information. So I have no doubt that when considering a sensitive document or a sensitive test the clinician would advise or counsel their patient to be aware of their right for it not to be uploaded into My Health Record. If they do not opt out of that document being uploaded to My Health Record, they can of course, at any time, exercise the privacy controls that my colleague mentioned, and either put an access code across the individual document or across the whole record or actually mask the document from view altogether.

Senator GRIFF: So the upload system varies? Or it's a common upload system when a hospital or a doctor wants to send data to you? It's a portal of some kind?

Mr Kelsey : Well, no. The software on each of these locations is accredited by us to be what's called 'conformant to the My Health Record'. That means that it's able to connect to the My Health Record and upload documents where it's appropriate to the My Health Record.

Senator GRIFF: Does the system time out? Are there fail-safes? If somebody's got the screen open, got the system open, will it actually time out after a period of time?

Mr Kelsey : Yes. These are all part of the conformance requirements that software providers have to meet.

Senator GRIFF: Thanks.

CHAIR: Senator Di Natale.

Senator DI NATALE: Going back to that, you have the three-month period and you're putting a lot of work into letting people know what's about to happen. But I think we can reasonably expect that, despite your best efforts a lot of people will not be aware that they've had a record established. You said it's basically activated at their first clinical encounter. Can you just talk me through that process? What happens? For example, Joe Blow makes an appointment with their GP in January of next year. It's their first appointment since the October deadline has passed. When does it get activated? Is it the point I go in or is it the time I make the appointment? When does it get activated?

Mr Kelsey : It's the point at which the software in that clinician's practice searches the DHS database to identify your unique health identifier, to which is attached your My Health Record. It's the moment that that software interaction takes place.

Senator DI NATALE: But when does that normally—I'm not a technical person—

Ms McMahon : It's typically when a clinician tries to view the information or when a document is uploaded. Earlier I described how in a community pharmacy the dispense record is sent; that would trigger the activation. If a general practitioner clicked on the My Health Record tab and viewed information—that type of interaction.

Senator DI NATALE: You might see your see your appointment list for tomorrow and you might look up—'I haven't seen person X for a few months and I'll just refresh myself. I know there was an issue last time.' That person might not actually be aware that the health record has been established until they've had the clinical encounter?

Mr Kelsey : That's correct. The whole point of opt out is that—

Senator DI NATALE: I'm aware of it. I know what the point is. I just think that, despite your best efforts, there's going to be a bunch of people who will have no idea that this is happening. That's just the reality, isn't it?

Mr Kelsey : What I said earlier is that, in the event there is someone who doesn't know that they could have opted out, they can then cancel their record any time after the opt-out period has expired. If they haven't had a clinical encounter, there won't be any data in it anyway.

Senator DI NATALE: The MBS and PBS data would be downloaded.

Mr Kelsey : Only when it's activated.

Senator DI NATALE: Yes, but it would be activated when the healthcare provider—

Mr Kelsey : Yes, but if they haven't seen—so, in a situation where I haven't seen a healthcare provider and/or I haven't personally activated the record, there will be nothing in it. So, if you then choose to—

Senator DI NATALE: I'm aware of that. I suppose I'm thinking of a case of—you know, you go and see a GP, and you might have been treated for something that's very sensitive. Even though you're not getting clinical information, you are getting a list of prescription medicines which gives you a good clue as to what's going on. The GP will have that information prior to you having visited them if they've accessed your record. That's the question.

Mr Kelsey : Yes. That's correct.

Senator DI NATALE: And so there will be people who I suppose will be a little surprised. As you say, in some cases they might not actually have seen the record, but in some cases that will have happened—obviously, seeing a prescription from a pharmacist. In the setting of a pharmacy, is there an onus on the pharmacist to say, 'You now have a health record, and any information I enter now will be uploaded'? How is that going to happen?

Mr Kelsey : The Pharmaceutical Society of Australia has published guidelines for pharmacies in which they exactly explain what best practice looks like, which would be a conversation. Similarly, the AMA has published guidance, which is being refreshed at the moment, to support broader clinician understanding of what best practice is.

Ms McMahon : But there's no legislative requirement for healthcare providers to raise awareness amongst consumers. That's our role as system operator.

Senator DI NATALE: Are you encouraging health professionals to have this conversation prior to that?

Ms McMahon : Yes, we are. That's what Tim mentioned.

Senator DI NATALE: You mentioned that there were guidelines. You didn't say what they were.

Mr Kelsey : And so are the peak bodies. The Pharmaceutical Society has published guidance which is put together in consultation with its membership, for example, in order to precisely prescribe what best practice—having a conversation—looks like for pharmacists.

Senator DI NATALE: Do those guidelines reflect that that conversation ideally takes place before the record is—

Ms McMahon : An individual healthcare provider is unlikely to know whether a record has been activated or not until they view it, so a pharmacist, for example, won't know whether the consumer has opted out. So, practically speaking—

Senator DI NATALE: Practically, they'll look at it. The information will be downloaded because it's been activated through that encounter. Then they'll have a conversation with the patient?

Ms McMahon : They'll look at it, and there may be data in it or there may not be.

Senator DI NATALE: Yes. It's good to have a sense of what it looks like when it's actually working rather than theoretical. In most cases you'd expect the information will be downloaded at the point of the clinical encounter because, as you say, they've got to download it to enter the information.

Mr Kelsey : Or, indeed, as we know from Berrigan, the individuals themselves have the ability to upload documents that they want to, including an advanced-care directive, for example, and only they are able to do that. That's one reason why people would want to activate their record other than in the case of a clinical encounter: to take advantage of some of those self-service functionalities.

Senator DI NATALE: I'm thinking more of a person who doesn't know this thing is happening, finds out about it and says, 'Oh, I don't want to be part of it.' I just want to know what protections there are. At that point during the clinical encounter, the person would say, 'Actually, I don't want to be a part of this.' What happens next? Say they're at the pharmacy.

Mr Kelsey : There are a number of things. If they wish, they can go online and locate their My Health Record. They can then delete it altogether. They can take advantage of the privacy controls to, say, put in a PIN number or delete the document they don't want to be present in their record. There are a number of options open to them. They can also do that via the call centre in relation to deleting the record itself.

Senator DI NATALE: Okay. I suppose they can't do it within the clinical setting, really. It's going to be an action that they take afterwards.

Ms McMahon : That's right. They need to contact us through one of those channels partly because we'd have to verify their identity to perform that action.

CHAIR: It's completely understandable you don't want medical practitioners being able to alter people's records without their consent. How about if a practitioner accidentally uploads something? Can they remove that, or do they have to seek the patient's permission?

Ms McMahon : They can remove that. The conformance software all has a requirement that an uploaded document can also be removed if it was incorrectly uploaded.

CHAIR: Okay.

Senator DI NATALE: So just what happens after that point is the person's record is effectively wiped if they decide they've don't want to be part of it, and no-one else will have access to the information except for the information that was available through the previous clinical encounter?

Mr Kelsey : That's correct.

Senator DI NATALE: I will ask you about the discharge summaries and the GP health summary. The GP health summary is likely not to be in PDF format. I don't know what the technical language is, but it will be in computer speak?

Ms McMahon : It will be CDA format.

Senator DI NATALE: CDA is the code or something that's used, is it?

Ms McMahon : Yes.

Senator DI NATALE: But when discharging someone from hospital, I can't believe we're still in the era of these awful bits of scribble that tend to be distributed after a hospital admission. Why isn't there a similar code within the discharge summary environment?

Ms McMahon : There is. The vast majority—around 95 per cent—of hospital discharge summaries are in CDA format. Some are PDF. They're not a scanned PDF with scribbles on it; they're a tight readable document but in a PDF format rather than CDA.

Senator DI NATALE: Will that be because it will have been through the medical records department, encoded and—

Ms McMahon : It's usually just because of the capability of the software used by that particular hospital, public or private. Most hospitals, especially in the public estate, are uploading the structured data records which are the CDA formats.

Senator DI NATALE: Why are they in PDF format? Is that the same for the GP summaries?

Ms McMahon : No, the shared health summaries are all in CDA format. There are no PDF shared summaries.

Senator DI NATALE: Why are they in PDF format if they're using the same code?

Ms McMahon : It's the technical limitations of the software package chosen by the particular hospital, which hasn't got the capability to upload a structured document in CDA format.

Senator DI NATALE: You're moving in that direction, obviously. Are you hoping that changes over time?

Ms McMahon : That's right. CDA formats have structured data that allow for decision support—the sorts of features that Senator Brockman mentioned earlier around alerts and other things—rather than PDF documents.

Senator DI NATALE: Can I ask about the secondary users? A couple of people have raised questions of insurance assessments, employer assessments and so on. As an individual, you can choose what you want other health practitioners to see. Is that right?

Mr Kelsey : To be absolutely clear, only a registered health practitioner treating you is authorised to look at your record, and that's the point of both the conformance and certification of individuals and organisations. So that would mean anyone wanting to access data for any other purpose would have to seek your individual consent for that or would have to go through the framework.

Senator DI NATALE: What about a pre-employment medical, for example? You might not want your prospective employer to know you've been treated for a mental health issue, a sexual health issue, maybe a sensitive issue.

Mr Kelsey : Unless you gave them your consent, they would have no access to My Health Record.

Senator DI NATALE: So, for example, can there be pressure applied on the individual to disclose that information?

Ms McMahon : The My Health Record's act specifically lists authorised uses of the information in the My Health Record which relate to the primary purpose, which we're discussing at the moment and secondary use, which we've discussed. Releasing that information for a purpose that's not related to care or to one of the authorised secondary uses would be an unauthorised disclosure of that information.

Mr Kelsey : Unless you gave your consent.

Senator DI NATALE: So, again, individuals can clearly state they don't want information for insurance purposes or for pre-employment purposes to be accessed by a prospective employer?

Mr Kelsey : The only way that data could be visible in those circumstances would be if the consumer themselves had provided that information. There's no facility for those parties to have any other reason to access one's record.

Senator DI NATALE: The concern is, if you're not doing that, you're hiding something. If it's something for insurance purposes, compensation purposes, what are the protections in that sense?

Mr Kelsey : I think that's a broader sort of social question which would go to broader criminal conduct in relation to forcing people to do things against their will.

Senator DI NATALE: But the act specifically outlines purposes for which the information can be used and the secondary purposes—

Mr Kelsey : Yes, that's correct.

Senator WATT: Has any consideration being given, either by the agency or by the department, to putting in place some sort of new penalties against people who inappropriately force the giving of consent?

To take Senator Di Natale's pre-employment situation, it's not difficult to envisage a situation where someone might be pretty desperate for a job and a prospective employer applies pressure to them to consent to the release of the information. Sure, it can't happen without their consent, but in this evolving world of data and privacy has any consideration been given to new precautions to stop that sort of abuse?

Ms Edwards : I would make the point that forced consent is not consent. Going back to first principles, if anyone is coerced into giving their consent I think there would be a good argument that that is not consent at all. There are very strong penalties in the act against unauthorised use, which I can take on notice to refer you to the detail of. Certainly, in coming up with the legislation and all the rules and the workings we do, there is absolute primary consideration given to privacy and so on. I will take away the point you've made and check it out.

Senator WATT: Thanks.

Senator O'NEILL: Are you aware of the recent report of the Parliamentary Joint Committee on Corporations and Financial Services inquiry into the insurance sector? We received evidence from the AMA and the Royal Australian College of GPs of very significant and frequent demands from insurers for the entire record, with the imprimatur of a tick on a form signed many years previously which basically gave them the permission you are talking about—permission to access those full records. In fact, the AMA sat in a room not far from here and said that 100 per cent of the inquiries they received were requests for the entire health record to be handed over. Is the department aware of that and recommendations that have been raised, and of current conversations that are happening between the Financial Services Council and the Royal Australian College of GPs around mitigating this problem from both sides—the request side and the easy delivery of the information as a lump sum?

Ms Edwards : I am not personally aware of it. I am sure my colleagues would be.

Senator O'NEILL: Can I alert you to that.

Ms Edwards : I will certainly take it away for our team and the Digital Health Team to have a look at those recommendations and comments.

Senator O'NEILL: There is work to be done in that field as well, to provide protection here.

Ms Edwards : Thank you, Senator.

CHAIR: Senator Smith.

Ms Edwards : Can I return to your question from before, Senator Smith. I didn't want to let down your confidence in me! I have found the reference to opt-out reasons. It appears on page 243 of the report, at table 3. The top three reasons in the North Queensland and Nepean-Blue Mountains areas for opt-out were 'I have no use for digital health record', 'I prefer to manage my medical records on my own' and 'I prefer that my doctor manages my medical records'. The report comments that, in talking to those people, additional communication or a longer period of communication may well have overcome those concerns. That is the sort of research and analysis which the agency has taken into account in devising the current scheme.

Senator DEAN SMITH: That leads nicely to my first question. Why was a three-month period chosen and not, for example, a six-month period in regard to the opt-out?

Mr Kelsey : The opt-out trials tested two months. In that report, that was deemed to be too short. Three months was felt to be the right length of time for the level of communication that is necessary.

Senator DEAN SMITH: On that basis, six months could have been suitable as well. So why did we choose three months? Two months was identified as being too short.

Mr Kelsey : As I understand it, there was consultation with clinical leaders and so on. There is, as I said, a clinical urgency in realising an acceleration of clinical benefits. If three months, from the evidence we had, was regarded as a proper length of time for this conversation, that would mean there would be three months more of clinical benefits being realised for people who are otherwise potentially at risk of adverse drug events or other situations in health care.

Senator DEAN SMITH: Finally, I want to go to the difference between default access settings and advanced access settings. An e-health record gets established, and my understanding was that there were some default access arrangements and then there are the advanced access arrangements. How is the consumer aware that there are the default and advanced access arrangements? My understanding is that the advanced access arrangements give the consumer more control over their record. How are they being made aware of that element of privacy?

Ms McMahon : The advanced access controls you mention are the ones I described earlier: the record access control, the ability to mask certain documents and the ability to see the full history of all access. Those are the controls I described earlier.

Senator DEAN SMITH: They're the advanced controls?

Ms McMahon : Yes, what you're referring to as advanced controls we would consider to be that range of settings that a consumer can apply.

Senator DEAN SMITH: This is my point: the consumer has to consciously apply those advance settings. Is that correct?

Ms McMahon : That's right. If I, as a consumer, in My Health Record, wanted to be notified when a new healthcare organisation was accessing my record or my child's record, I would need to put in my mobile phone number or my email address and express whether I wanted a text message or an email, for example. That's one of the controls. I would need to go into the My Health Record and put those settings in place. So, a consumer needs to do that.

To the second part of your question on how we're raising the awareness of consumers about the availability of these controls and then how to use them—that's through our broader consumer communications campaign that Mr O'Connor listed earlier. We've got a range of direct communications to consumers through the healthcare providers and through a number of other community organisations, which he listed. We can provide the full list of those to you now, verbally, or on notice.

Senator DEAN SMITH: It might have been my misunderstanding. I thought the community awareness program was around the opt-out option, which is available for three months. I'm more interested in making sure that consumers are aware that they can have an advanced setting over their record and that, by doing nothing, they have the default setting.

Ms McMahon : Our consumer campaign is broader than just advising that people can opt out. It's raising awareness about the existence of the My Health Record and what it does. That's the starting point. It's also about their rights to opt out and the time frames in which they can do that. It's about their ability at any point later to cancel their record. And it's about the options they have around managing their own privacy and controlling their record. It has a number of layers. And, through the various stakeholders who are pushing out those messages and assisting us with that, we're attempting to get the messages out to consumers on all of those key points.

Mr Kelsey : The research conducted both during the opt-out period and subsequently confirmed that the public wanted to be communicated with about the following: Firstly, what is a My Health Record? Secondly, what are the benefits of the system and what are my rights to control who sees it? Thirdly, how can I opt out? And fourthly, where can I go for more information? That has been the basis on which we have constructed current communications, which are already active obviously, and looked at the design of the communications program during the course of the opt-out period and beyond.

CHAIR: I think that's it on program 1.2. No further questions? In that case, with the sincere thanks of the committee for a very interesting session, we will release the Australian Digital Health Agency and those officers from program 1.2 who are not required for later parts of the program. We've already released 1.3 and 1.4, so we shall move on to program 1.5, international policy.

Senator WATT: I've just got a few questions about the department's response to the latest Ebola outbreak in the Democratic Republic of Congo. You're the man, Professor Murphy?

Prof. Murphy : Yes. I've just been in Geneva at the World Health Assembly, speaking to the WHO director of emergency response, so I'm well aware of what's been happening.

Senator WATT: I'm hoping to get through this section in about five minutes, so can you very briefly tell us what the department is doing to monitor the new outbreak.

Prof. Murphy : We're in close consultation with the WHO, which is, through its emergency response arm, leading a very effective rapid response. They've got a hundred people on site in the Democratic Republic of Congo. They're currently implementing a ring vaccination program to protect further spread. They believe that this particular outbreak is very likely to be under control. The only concern is the city where there were a couple of cases just last week, but they feel it's coming under control.

The Australian government has committed $4 million to the response, through the Department of Foreign Affairs and Trade. That information was made available to the WHO last week. In terms of risk to Australians, there is very minimal risk—almost no risk. WHO has recommended exit screening of people leaving the Democratic Republic of Congo but that there is no value in entry screening, particularly as it's a very remote country which would be several plane trips away and the number of the cases is small. Our response has been to support the international aid effort led through the WHO, who are hopeful that this will be brought under control fairly quickly.

Senator WATT: Do we know anything about the number of Australians who go to or from the Congo each year?

Prof. Murphy : I don't know the exact number, but foreign affairs are fairly confident that there are no Australians in that area, obviously other than WHO staff—many of whom are Australians—who are working in the response under appropriate controls.

Senator WATT: Has the government sought any advice from you or the department more generally on this latest Ebola outbreak?

Prof. Murphy : Absolutely—the health protection department in the Department of Health has briefed the government throughout the last few weeks on information gained from WHO. We've had a watching brief. We've stood up a small group in the department to monitor this issue, and they're liaising closely with foreign affairs to keep an eye on it.

Senator WATT: What was the branch?

Prof. Murphy : It's the health protection branch in our department.

Senator WATT: Was the advice that's been provided requested by government or was it provided unsolicited?

Prof. Murphy : I think we stood that up. I wasn't here at the time. I'd have to seek advice from my deputy, who was in charge at the time. But I believe that it was requested by government.

Senator WATT: Is she or he here?

Prof. Murphy : Not till the next outcome.

Senator WATT: Okay. Could you check that out for me. In terms of action taken by the government to address this latest outbreak—$4 million in funding to the WHO?

Prof. Murphy : Correct.

Senator WATT: You mentioned Australians who work for the WHO who've been sent.

Prof. Murphy : The director of the WHO's emergency response, Peter Salama, is an Australian. He went out there immediately with the director-general of the WHO, Dr Tedros. The WHO is very sensitive about responses to Ebola, having felt that their response last time was slow, and they've responded very promptly and very aggressively. He went out there on the ground and inspected the situation.

Senator WATT: Leaving aside those Australians who are part of the WHO contingent, who are now in Africa, have any other Australians been dispatched from Australia—departmental employees?

Prof. Murphy : No.

Senator WATT: So, in terms of Australians, it's just WHO personnel?

Prof. Murphy : The only personnel responding—that's correct.

Senator WATT: I'm not sure if this has come across your desk yet, but the shadow health minister and the shadow foreign affairs minister have written to Minister Hunt and Minister Bishop about this outbreak—the letter was dated 18 May—essentially committing a bipartisan approach here.

Prof. Murphy : Correct.

Senator WATT: Do you know whether anything has been done in response to that letter?

Prof. Murphy : I have seen that letter, and I have seen a response to that letter. I'm not sure whether that response has been sent. But there are responses being prepared by the department for the ministers.

Senator WATT: Is there anything the government is intending to do to take up that offer of bipartisanship?

Prof. Murphy : I think that's a question for the ministers, but there is really nothing more that government can do at the moment. This is well managed by the WHO. We've provided financial assistance, which is what they wanted. But we would certainly be happy, under the direction of the ministers, to further brief other members of parliament. But that's a decision for the ministers to make.

Senator WATT: Do you know anything about that, Minister?

Senator McKenzie: I can take it on notice.

Senator WATT: Has the $4 million that's been provided been publicly announced?

Prof. Murphy : I believe it has been publicly announced.

Ms Beauchamp : It was announced at the WHA meeting last week.

Senator WATT: Has there been a press release from a minister over here about it?

Ms Beauchamp : I'm sure there would have been a press release from Minister Bishop, but I'd have to—

Senator WATT: Okay, we'll have a look. That's it from us for 1.5.

CHAIR: Just quickly on 1.5, Professor Murphy, the Zika outbreak, which I guess came to prominence during the Olympics last year, seems to have faded, at least in the media. Is it still a concern?

Prof. Murphy : Zika is not as much of a concern as it was. The activity has reduced, but it is still there in some countries. There is not nearly as much activity in the spread of the virus as there was when that concern was on in Brazil, but there are still some areas of the world that have transmission of Zika virus. It's something we're keeping a watching brief on, but it's not posing any significant risk to us at the moment.

CHAIR: For example, it appeared—I don't think it was there previously—in relatively near neighbours of ours. Singapore, I think, had a small outbreak.

Prof. Murphy : Yes. We are connected to a very sensitive international surveillance system that is, again, run through the WHO. We all contribute epidemiology information, so, if any increase in activity was seen, we'd know about it very quickly.

Senator SINGH: To follow up from Senator Watt, is the $4 million that you said has been allocated for this Ebola outbreak coming out of the Health portfolio?

Prof. Murphy : No, it's coming from the foreign affairs portfolio. International health assistance comes from foreign affairs. That's how it's provided.

Senator SINGH: Thank you very much.

CHAIR: If there are any officers from program 1.5 who are not required later, we can release them, which means we are moving onto outcome 2, beginning with program 2.1: Mental health.

Senator O'NEILL: The first questions that I have go to the extension of the suicide prevention trial sites. I asked a number of questions about this matter at the last estimates. Following the last estimates, the department confirmed that a number of members and senators had written to the Minister for Health, encouraging him to consider extending the national suicide prevention trial. The department also confirmed that it was not aware of any PHNs writing to the Minister for Health regarding the extension of the national suicide prevention trial. If this has changed in recent times, could you please advise which PHNs did write to the minister or the department?

Ms Edwards : We're not aware of any subsequent correspondence from PHNs, but we can check that and come back to you if there has been any such contact since we last met.

Senator O'NEILL: Are you sure about that?

Ms Edwards : I'm sure that I'm not aware of any. I said I'll go and check to see if there's contact of which I'm not aware.

Senator O'NEILL: The letters that you received from us indicated a request for a 12-month extension. Are you aware of that?

Ms Edwards : Yes.

Senator O'NEILL: How did you present that information to the minister? Did you present that information or did the minister give it to you? What happened with that?

Ms Cole : Letters that are received in the minister's office are often passed on to the department for advice and/or drafting of a response. Those letters that we're referring to in the QONs are letters which went through that process, and that's why we're aware of them. Those are the relevant letters you were talking about from MPs and senators.

Senator O'NEILL: And you remain not aware of any PHNs having written to the Minister for Health.

Ms Cole : I do not recall any PHNs writing directly to the Minister for Health on this issue. However, we will go back and check all the correspondence records for you.

Ms Beauchamp : It's probably important to say though that, even if there are those letters, the government made significant announcements in the budget on suicide prevention and the trials, funding up to 25 primary health networks to roll out beyondblue's The Way Back Support Service.

Senator O'NEILL: I will get to questions on details about that, but I want to follow this line of questioning now. I'm trying to find out a little bit of detail on this. If the department or the minister has not received any advice from the experts—which, in this case, we're calling the PHNs—that they wanted any extension, how was the department able to advise the minister on his recent announcement that an extension was needed?

Ms Cole : Although the PHNs did not write to the minister, which was your question, we're aware that many of the community groups who were involved with the suicide prevention trials were indicating that they would like to see an extension. In addition, given how long it was taking to get services up and running in some of those sites, there was some basic thought that the evaluation period was not going to be long enough for us to come to a meaningful conclusion about the success or otherwise of those trials. Those things in combination were part of the thinking behind the advice that was provided to the minister.

Senator O'NEILL: Does it concern you, Ms Cole, that the information you've received came from community groups? It either wasn't give to the PHNs or the PHNs thought it was of insufficient import that they didn't bother to advise the department or the minister.

Ms Cole : The PHNs are involved in those community groups as well. You asked me quite directly: did any PHNs write to the minister on this issue? My advice to you was: I'm not aware of any PHNs writing directly.

Senator O'NEILL: I gave you a chance to correct the record this afternoon. You could have easily said, 'No, but community groups that are associated with the PHNs did,' but you continued to say, 'No, there's been no advice.' Pardon me, but I'm looking for fulsome answers to the questions that the community has asked me to be put you.

Senator McKenzie: Chair, I think the officer has been answering Senator O'Neill's question.

Senator O'NEILL: Senator McKenzie, you're not the chair anymore.

Senator McKenzie: I understand that but, as minister, I'm able to approach the chair and suggest that we give the officers a chance. You asked quite a direct question about whether anyone had written. They answered it and, following further questions, they've fleshed that out for you.

Senator O'NEILL: And now I'm critiquing the response from them.

CHAIR: Your job is not to critique the response; your job is to ask questions, Senator O'Neill.

Senator McKenzie: Thank you, Chair.

Senator O'NEILL: I want the truth in answer to those questions, Chair. I don't want some word game. I asked: did you receive information from the PHNs? In your answer, Ms Cole, when you clarified, you said that community groups that are associated with the PHNs have been in touch with you. Surely that's close enough for you to have said something about the PHNs.

Ms Edwards : I had understood that you were following up on—you simply referred to correspondence. We are not aware of any correspondence. We undertook to go and check that, which we will. Of course officers in Ms Cole's division are speaking to community groups, PHNs and all sorts of people involved in the suicide prevention trials and are monitoring them closely all the time. In the course of that work, they gathered information from PHNs, from community groups, from the basis of our own material and from published literature, which gave us a suggestion that an extension would be warranted, and advice was provided by the minister. The minister then made a decision to extend the trials.

Senator O'NEILL: And there were six letters from Labor members of parliament.

Ms Edwards : No doubt letters to the minister would have also been taken into account by him on their receipt.

Senator O'NEILL: I want to get it on the record that I want full answers here, not half answers. Can the department clarify what advice or what processes it provided to the minister so he could make this decision?

Ms Edwards : The Minister is briefed. We provide advice to the minister on a range of issues, updates and decisions. One of the issues on which we provided advice was on the question of the duration of the trial. The minister decided to extend the trial.

Senator O'NEILL: What was the basis of you giving him that advice? What research did you undertake?

Ms Edwards : I think I just indicated that we based our advice on interactions with the PHNs and community groups, on our understanding of the progress of the trials from our own records and on academic literature.

Senator O'NEILL: Were all of these just phone conversations? Did you receive anything in writing at all?

Ms Beauchamp : My understanding is, last year—it was before I started—a number of organisations, particularly mental health organisations, met to identify cross-sector gaps in mental health services where their collective expertise, skills and knowledge would have the greatest impact. I think suicide prevention was identified as one of the most urgent priorities after the department and the government had received advice from a number of mental health organisations.

Senator O'NEILL: What date did you indicate that was?

Ms Beauchamp : I think it was across a number of states and key organisations. I'd have to find the exact details, but my advice is that that occurred sometime in 2017.

Senator O'NEILL: A letter from the minister states, 'Changes to the scope and length of the trial will be considered in consultation with PHNs and the evaluation steering committee.' Can the department detail when consultations started with the PHNs and the evaluation committee, and who this consultation was with? Indeed, who's on the evaluation committee?

Ms Cole : We'll take on notice the members of the evaluation committee for you.

Senator O'NEILL: Is that because you don't know them or because you don't want to disclose them?

Ms Cole : I don't have them listed on my papers right now. I'll take that on notice. The evaluation committee hasn't been going that long, as the evaluator was only chosen in November or December. It would have been some time around that period.

Senator O'NEILL: So the evaluator was chosen in November last year?

Ms Cole : I'll check that date for you. We've got it somewhere in our things. We went through an ATM process and a relevant university was chosen.

Senator O'NEILL: Ms Beauchamp, in the interim could you clarify the intersection of what you described as consultations during 2017 that led to this extension by the minister and the evaluation committee and its processes? Are they parallel; are they integrated; did one precede the other?

Ms Cole : Sorry, Senator. I just need to correct my previous evidence. It was actually February this year that the tender for the evaluation process was completed. Sorry, what was your second question?

Senator O'NEILL: If I can go back to Ms Beauchamp, if the evaluation committee evaluator, the person who leads that committee, I'm assuming—is that correct?

Ms Cole : The evaluation is being done by the University of Melbourne. It has an advisory committee to help it with the technical and policy issues surrounding the trials and the evaluation. We'll get you those members on notice, as I mentioned earlier.

Senator O'NEILL: When you say evaluator, you mean the institute that won the tender—not a single individual?

Ms Cole : Yes, that's what I mean.

Senator O'NEILL: So that came in February 2018. That goes to the question I was asking Ms Beauchamp. You indicated that conversations or evaluations throughout the course of 2017 led to this announcement.

Ms Beauchamp : I'd have to take on notice all the details of those consultations that did occur and get back to you.

Senator O'NEILL: To be clear: can the department detail when consultations started with the PHNs around—

Ms Beauchamp : I'm not talking about just PHNs. I'm talking about a number of relevant organisations.

Senator O'NEILL: If you can separate them out for me, I'm particularly interested in your consultations with the PHNs, when they occurred, where they occurred and who was present.

Ms Cole : We talk to PHNs all the time about a variety of issues. I and the relevant officer who is responsible for the PHN programs and the mental health programs, the four of us, are in contact with those PHNs almost daily, so your request could be difficult to answer, from that point of view.

Ms Edwards : Perhaps we could outline key events or documented meetings or so on that come up in our records and also give you a flavour of the regular contact that happens between officers and PHNs on a day-to-day basis.

CHAIR: Could I just jump in there to clarify. The design and evaluation of the trials is not the role of the PHNs?

Ms Cole : That's correct.

CHAIR: The PHNs are effectively the service delivery agents on the ground?

Ms Cole : That's correct.

CHAIR: So can you clarify who was doing the design and evaluation?

Ms Cole : The design of the evaluation was done by the department in conjunction with various experts to make sure that we got the tender correct. Then the evaluation itself, which is being done by the University of Melbourne, has an advisory committee to assist it in terms of any questions or technical issues that might come up during the evaluation; for example, how we're going to get some data to be able to show before and after the trials themselves—that kind of thing. The PHNs, as you correctly attribute them, are actually the service deliverers. They're the ones handling the funding on the ground. They're also doing the infrastructure underneath the trials, in terms of setting up community advisory groups and working with them to determine what steps will be taken at each location and, similarly, what will be funded at each location for each of the trials.

Senator O'NEILL: Can I go back to the minister's letter, which says, 'Changes to the scope and length of the trial will be considered in consultation with PHNs and the evaluation steering committee.' Can you detail when these changes to the scope and length of the trial were considered in consultation with the PHNs and the evaluation steering committee?

Ms Cole : In relation to the evaluation steering committee, I'll come back to you with dates on notice. In terms of the PHNs, we have a constant conversation with them. One of those conversations is often, for example, the length of various programs, what they're up to, that sort of thing. In those conversations, some of the PHNs have mentioned that they think it would be beneficial to have an extension of the trials. To document that is going to be very difficult, because they are casual conversations that we have PHNs all the time.

Senator SIEWERT: That letter implies a much more formal process. Taking on board what you've said about that to and fro, which I understand, did you have a formal process of going to the PHNs and consulting around this specific issue?

Ms Cole : No, we did not, because we already knew what their views were.

Senator O'NEILL: So when the Minister wrote this, 'The trial will be considered in consultation with the PHNs and the evaluation steer committee', as Senator Siewert has indicated, that creates an impression of a formalised process. With the short period of time from February estimates to now can the department explain how comprehensive these consultations were with the PHNs and the evaluation committee, given there was an additional $13 million allocated to the trials? I would hate to think it was just on the basis of conversations.

Ms Edwards : There may not have been a formal consultation process in the way you might have expected.

Senator O'NEILL: From the Minister's letter.

Ms Edwards : Engagement with the PHNs actually entails a genuine and rich consultation, day to day, a true relationship between us, an engagement where officers know each other very well and discuss issues up to daily throughout the teams that I lead. That is actually a very effective way of making sure we understand their views, including on this issue. It may not fit into the design you've taken away from the letter, but consultation it was and is. We continue to have very rich discussion with the PHNs every day.

Senator O'NEILL: I have a couple of concerns. I agree that this is of sufficient importance—we've been asking for this trial to be extended for a long time now. We understand that it's of sufficient importance, yet the processes don't seem to be very transparent or very careful. There's no correspondence. There are no reports. There are no detailed, written submissions from the PHNs to request this additional funding of this $13 million. Is that correct?

Ms Edwards : It's an ongoing collaboration.

Senator O'NEILL: Does this mean that anything that the PHNs want, they don't need to go through a formal process? They just need to keep talking to you and get what they want when they want it? You can't have it both ways.

Senator McKenzie: That is not what the officer said, Senator O'Neill.

Ms Edwards : I think in my previous answer I made it clear that the views expressed by the PHNs, by other community groups, from our own knowledge in the department and also from academic resources, a broad advice was provided to the minister, and the minister, also having other correspondence to him directly, as you pointed out, made the decision to extend the trials.

Senator O'NEILL: So the minister made the decision?

Ms Edwards : Yes.

Senator O'NEILL: You mentioned academic resources. What were they and who were they from?

Ms Edwards : I'd have to take it on notice. We have a lot of expertise in our teams. They spend a lot of time getting across material. Ms Cole may know more.

Ms Cole : The other thing to take into account is that we fund the Black Dog Institute to support the trials over the period of the trials, in terms of technical advice and academic advice. They were obviously keen to see the trials run for an appropriate period as well.

Senator O'NEILL: Did they provide a written request for an extension to the trials to you?

Ms Cole : I will have to check.

Ms Beauchamp : Could I just add, in terms of providing advice and for the government to make decisions, including the minister, it's not only letters we rely on and advice from other organisations. We actually look at the evidence. When you start having a look at the evidence base around suicide in Australia and the groups most affected and the like, we do draw on research that's commissioned and also research that's available through ABS, AIHW and others on suicide prevalence and the like, in terms of giving our departmental advice to the minister and the government when considering any changes in policy or initiatives.

Senator O'NEILL: Given that you were preparing this advice, can you indicate when you gave this advice to the minister? Did you advise the minister, 'You should extend the trials and you should make it $13 million'?

Ms Edwards : Senator, you would be aware that we don't reveal the content of our advice to the minister.

Senator O'NEILL: Did you provide formal advice to the minister around this?

Ms Edwards : Yes.

Senator O'NEILL: When did you do that?

Ms Beauchamp : We would have done that through the budget process. We're always providing advice to the minister on a range of matters.

Senator O'NEILL: Can we be specific to this matter—the $13 million that was announced in response to the extension requests of the PHNs that were advocated by many Labor members and community groups attached to PHNs?

CHAIR: You don't seem happy about it, Senator O'Neill.

Senator O'NEILL: I'm happy about the quantum. I'm just concerned about some of the processes. When did that evidence that you say you drew on and your recommendation go to the minister as part of the budget process—what date?

Ms Beauchamp : I'd have to take that on notice, but we don't normally provide information in confidence around—

Senator O'NEILL: I'm not asking about the detail. I'm well within my rights to ask what date.

Ms Beauchamp : Let me take that on notice. We're providing the minister with advice all the time, every day. I'd have to go back and single out exactly what pieces of advice were provided and when.

Senator O'NEILL: You said it was as part of the budget process?

Ms Beauchamp : When we're looking at any figures and changes in policy or extensions of funding, that's normally based on advice provided by the department to the ministers.

Senator O'NEILL: When those pieces of advice are funded, they're normally locatable within the budget. Why wasn't the trial site extension announced as part of the budget?

Ms Beauchamp : Why was it announced as part of the Budget?

Senator O'NEILL: It wasn't.

Ms Edwards : It was announced on 14 May.

Senator O'NEILL: What was the catalyst for the minister to announce it after the budget, so that it wasn't announced as part of the budget?

Ms Edwards : There wasn't a specific budget measure in relation to the extension because additional resourcing was found within an existing program.

Senator O'NEILL: Which program?

Ms Cole : The money is found within 2.1, the mental health funding.

Senator O'NEILL: This is mental health funding, $13 million that's come from somewhere else.

Ms Edwards : It's the outcome we're now discussing within that program.

Senator O'NEILL: What was it allocated to before?

Ms Edwards : It was within the money allocated to 2.1. It was available and it was allocated to this priority. The minister announced it on 14 May.

Senator O'NEILL: To be clear, this is not additional money? That's why it wasn't announced as part of the budget. It was already in the budget.

Ms Edwards : It was in the existing program.

Ms Cole : It was within the forward estimates already available.

Senator O'NEILL: So this was not money attached to this year's budget? It was money attached to the previous year's budget?

Ms Edwards : It's not a specific measure in the budget. It's an allocation of money within the current program across the forward estimates.

Senator O'NEILL: I'll come back with a more detailed question on that one. Why did it take the minister so long to make his decision to extend the trial sites, when it had been called on for such a long period of time?

CHAIR: I don't think you need to answer that question.

Senator O'NEILL: Maybe it was because there weren't clear processes about informing his decision. When did the minister make this decision to extend the 12 suicide prevention trial sites?

Ms Edwards : It was announced on 14 May, as I think I indicated.

Senator O'NEILL: Did you give him advice around that period of time or prior?

Senator McKenzie: They've already taken that on notice. They'll get back to you with the date on that. We've been really clear. We seem to be going around in circles.

Senator O'NEILL: Just tell me out here, did you give the minister information? Did the minister decide to extend the 12 suicide prevention trial sites before or after the budget?

Senator McKenzie: It's taken on notice.

Senator O'NEILL: Did you provide your advice before the budget or after the budget?

Ms Edwards : We provided our advice before the announcement.

Senator O'NEILL: Before the announcement but after the budget?

Ms Edwards : We've taken it on notice.

Senator McKENZIE: We have already taken it on notice.

Senator O'NEILL: It doesn't seem to be a particularly difficult question to answer. So could I ask you to see if you could find that out and get that back to me today? The 13 million came as part of the general funding that was in 2.1; is that correct?

Ms Cole : That's correct.

Senator O'NEILL: And the quantum of funds in the 2.1 is how much?

Ms Cole : In the relevant financial year, which is the financial year coming, so 2018-19, the mental health bucket available under 2.1 is around 800 million.

Ms Edwards : 856.4 million I think. Yes.

Ms Cole : 856.4 million.

Senator O'NEILL: 13 million of that now has been allocated to the extension of the trial sites?

Ms Cole : That's correct.

Senator O'NEILL: Thank you. And can the department provide details about how the 13 million will be allocated across those 12 trial sites?

Ms Cole : It's on the same formula as the original funding, which means there's a million dollars for the extra year for each of the sites, and there is also some additional money to extend the evaluation for that extra year and also to extend the support supplied by the Black Dog Institute to the trials.

Senator O'NEILL: How much is for the evaluation and for the Black Dog Institute of that million; is it split evenly?

Ms Cole : So those are currently being negotiated. They will be no more than—I think it's up to $400,000 for the evaluator and up to $600,000 for Black Dog Institute. But I'll just confirm, it may be the other way around for those two.

Senator O'NEILL: Okay, that's fine. But there will be no additional funding to answer the concern about the remote communities who were under the impression that they were going to get additional funding to deal with the geographical reality and the costs of moving across large areas in regional Australia?

Ms Cole : Those costs have been basically met largely by the PHN already in terms of the travel costs for community members and so forth. The answer that we gave you around this very issue in the QONs outlined quite clearly that there had been minimal expenditure on that kind of thing, because it had been found within the PHN's general administrative budget on the whole.

Senator O'NEILL: So the $1 million that's been allocated, or $3 million in each situation with the $1 million additional now, none of that budget is going to operational matters, such as petrol in cars or accommodation? The PHNs are finding that from—

Ms Cole : Generally that's what's happening. There is some minimal expenditure. I'll have to give you a breakdown by each PHN to be able to answer that question more.

Senator O'NEILL: That would be of great interest, frankly, because the burden of that cost in the remote contexts—and I'm mindful of Senator Dodson being here; up in Western Australia it's a very significant issue—and for regional and rural Queensland and in some parts of the north of New South Wales, these concerns about the costs of travel have certainly been well articulated by those communities. You can't confirm that all of the funding is quarantined for on-the-ground services only?

Ms Cole : Some of the funding is not actually quarantined for on-the-ground services in the sense of actual clinical services. Some of the funding is being used, for example, for training of local community members and so forth, in order to help them be able to identify people who may be suicidal or who may need a little assistance. So, for example, quite a few of the sites have indicated that they're going to have or are going to expend money on training community members through things like mental health first aid and some of the other more specific suicide prevention training type programs. And some of the sites have also indicated that they're doing some specialised training for GPs, for example, to assist them to be able to deal with people in this situation more readily.

Senator O'NEILL: Will you be able to provide a report that indicates, by suicide prevention trial site—maybe like a pie chart, indicating the ways in which the funding that's already been used has been allocated to different parts, and clearly identify where funds have gone to the practicalities of simply moving people around?

Ms Cole : Yes, I can do that for you.

Senator O'NEILL: And a breakdown with the training education, the community education and awareness raising?

Ms Cole : Yes. To get those specific numbers we'll have to go back to each site, so it's not something we'll be able to do today.

Senator O'NEILL: I understand.

Ms Cole : Thank you.

Senator O'NEILL: And service provision clearly is something where people are really interested in finding out how much of this money is going in to create the space that fills those service gaps that were there in the first place.

Ms Cole : Yes.

Senator O'NEILL: When you're doing that, could you indicate for each trial site how much of the funding's been spent to date for each location?

Ms Cole : Yes, we can do that too.

Senator O'NEILL: Great. And can you say generally if they're roughly keeping on track with their spend?

Ms Cole : Most of the trial sites have taken quite a while to get their community organisations or their community working groups working well and at a stage where they're able to actually endorse decisions. So most of them are behind in terms of expenditure.

Senator O'NEILL: So we've got a pretty significant time lag.

Ms Cole : Yes.

Senator O'NEILL: How do you expect that to affect the evaluation?

Ms Cole : I think that, because we've got the extra year, we will actually be fine. I don't think that we will necessarily be able to see a direct correlation between the number of suicides within the sites, but what we may start to see is some community comfort, I guess, around the issues improving. Also, possibly, if we're lucky we'll be able to see something in terms of the self-harm statistics being reported within those areas.

Senator O'NEILL: Thank you.

CHAIR: I've got a few questions on the suicide prevention trial sites, and I suspect Senator Siewert may have as well. Am I correct in saying that part of the structure of the program is that we've got the trial sites to try and generate a varying range of approaches and through the evaluation process we're trying to work out what works best in certain contexts—that's part of the process we're undergoing here?

Ms Cole : That's exactly right. It's not only the geographical differences between the sites but also the target groups. The suicide prevention sites were asked to concentrate on the four very high risk groups. One of those is, for example, veterans, and the Townsville site is primarily focusing on veterans as a result. Similarly, we've got our two Aboriginal sites, in Darwin and the Kimberley, and there we're trying to work out what works best in the city situation versus the remote situation in terms of the best sort of methodologies, I guess, or the best tools that work in those situations, given how different they are, while they're still looking at a target population with a very high suicide rate in both of those communities. Some of the other rural ones are looking at farmers, which has its own set of particular problems in terms of communication with those individuals and so on.

CHAIR: And part of the evaluation process is going to be comparing like with like, so we're going to compare—

Ms Cole : Yes, where we can.

CHAIR: regional areas in Western Australia with regional areas in New South Wales?

Ms Cole : That's right. The idea is that, for example, if something works well in the Kimberley, it may well work in the Cape York region as well, where you've got a similar population. It doesn't necessarily mean that the sites will directly compare one to one with each other but more that we've got enough different situations to be able to apply successful interventions into similar geographical areas with similar problems.

CHAIR: Are different trial sites at very different stages of work? What's the variation between the most advanced and, I guess, the one that's still working up?

Ms Cole : The two that I'm most familiar with, for example, are the Kimberley and Darwin, and I would say that Kimberley is considerably more advanced than Darwin. Part of the reason for that is that it has been much easier within the Kimberley to identify the community leaders to talk to and the number of communities to focus on. Darwin has been much harder because, while you do have the local people, the Larrakia people, you also have a number of transient populations in and out who you also want to target, and actually getting a handle on that group and consulting with it has proved to be quite difficult.

CHAIR: I guess it's the PHNs and through them to you. Are you getting feedback from local communities? How are the individual programs, the individual sites, being embraced by local communities?

Ms Cole : I think most of them were concerned about how slow it was at the beginning, but, now that they're seeing services and education and so forth rolled out, they're starting to embrace it. The Townsville one is a good example of that. There was a lot of concern around how long it took to actually get it up and moving. But I understand that that veterans community generally within the Townsville region is very supportive of the trial now that they're starting to see things on the ground.

CHAIR: Can you just talk me through—and if this is a different topic, I'll go to Senator Siewert rather than talk about it here—the Million Minds Mission. Does that tie in to these trial sites, or is that completely separate?

Ms Cole : That's separate in the sense that that's an MRFF.

CHAIR: In that case, I'll ask about it later. We'll go to Senator Siewert.

Senator SIEWERT: I have a few questions around a couple of the smaller programs, before I move on to the bigger programs. In the budget there's the funding for the Junction Clubhouse, Head to Health, and Lifeline for crises, although that's a bigger allocation of funding, and then the prioritising of mental health. I'm not commenting on the value of the programs. What I'm asking is: how is the decision-making made around some of those program allocations? Are they tender rounds? How is the decision made to pick out those programs for funding?

Ms Edwards : There's a combination of ways it comes to the attention of the government. We have pre-budget submissions and so on from organisations. We have a lot of intelligence that we have gathered in the context of the mental health program. Obviously, it's a very large program, as you know. We're doing lots of various things. Sometimes the department is aware of where there might be gaps or ways whereby we can get really good, effective value for money on large or small programs to extend and so on. Obviously, the minister is also meeting with stakeholders, and they will be passing on views to him. There wasn't an open round to do with this particular injection into the mental health arena, but we are at a place where we spend $4.2 billion a year on mental health. We're looking across that suite of measures to see where there are additional things that we can apply money to to either fill gaps or respond to particular emerging demands. So it's in response to those types of factors that this package is put together.

Senator SIEWERT: How do you do the evaluation? Again, I'm not passing any comment on the value of these programs. How do you look at what you've funded already? There's some ongoing evaluation, but how do you know that these are the best value for money programs in terms of producing the outcome? I don't mean just value for money but producing the outcome.

Ms Edwards : It's a complex process. If you look at something like suicide prevention, there is a large suite of activity that was already underway, and what was announced in the current budget was some additional elements to augment areas. That makes the evaluation across the whole suite complex, but, of course, it wouldn't be appropriate to wait and see if we can see ways to actually help now. For example, the extension to Lifeline is something where we will say: 'Right. We know that's the front door in for lots of people in distress.' Yes, it makes it more complex, but, as always, when you are dealing with real, live human beings, we don't want to wait and see. We want to step in where we can and then devise more complex evaluation processes to see how we're going and try and disaggregate.

Senator SIEWERT: For the programs that you've funded in this round, will there be an evaluation process beyond whoever puts in their next pre-budget submission?

Ms Edwards : There's a mixture. Some programs, particularly the larger ones, have evaluation inherent within them. Ms Cole may be able to help me on the specifics.

Ms Cole : I might go back to Head to Health, which you mentioned. Head to Health is a little bit different, because it was developed in response to the Mental Health Commission's recommendations back in 2014. With Head to Health, we were able to find spare money to set that up, but to be able to maintain it long term we needed a budget initiative. It's got two years, because we're going to evaluate it towards the end of that period and consider at that point whether it's done its purpose, which was essentially to act as a front door to direct people to the right digital service.

Junction Clubhouse was the other one. Junction Clubhouse has been funded from the department since about 2013, I believe. It's very similar to many of the other programs we fund under Day to Day Living. In fact, actually it's provided by some Day to Day Living providers in Queensland, but in the Cairns region. Because it hasn't been formally in the Day to Day Living program stream, it didn't fall under the same extensions that we gave them all until 2019. So essentially what we're doing is just extending that and bringing it in line. What other programs did you mention?

Senator SIEWERT: SANE Australia's program.

Ms Cole : So SANE is one year funding only, with a trial of that campaign with an evaluation.

Senator SIEWERT: The evaluation is already built into the process?

Ms Cole : That's correct.

Senator SIEWERT: I want to go to a couple of the other funding programs: the after-care following a suicide attempt, the allocation of $37.6 million. From the information in the budget papers, that's to go to the PHNs to run. Is that correct?

Ms Cole : Yes, that's correct. The reason for that is that for the program to be successful requires a partnership, essentially, between the hospitals in the region and the local service providers, and the PHNs, essentially, broker that relationship.

Senator SIEWERT: Can you tell me then what role beyondblue has in terms of the funding that's going then to the PHNs for both components of the program? They're getting $10.5 million to provide national support and oversee the program, and then the rest of the funding presumably is then for the implementation of the program?

Ms Edwards : Yes, it's a three-way partnership. As Ms Cole mentioned, the PHNs are involved in order to make sure we get in with hospitals, but beyondblue have the model and a lot of the control over that. So it's PHNs engaging with beyondblue and with hospitals to make sure that the care is happening after a suicide attempt. Beyondblue is actually contributing some money itself, and we're seeking to leverage state and territory contribution as well, because, as you know, this is a complex across.

Senator SIEWERT: I'm not quite sure what role beyondblue plays out of that?

Ms Cole : So beyondblue doesn't deliver on the ground, but, essentially, they're providing support to the PHNs in terms of making sure that model on the ground has what we call model fidelity, so it actually matches what they've found or trialled to be successful. Beyondblue's also has a role to provide technical advice. Finally, the last part of it is that we're hoping that the states and territories will be involved and including beyondblue helps us to facilitate that kind of partnership.

Senator SIEWERT: It seems like a lot of money: $10.5 million—I presume that $10.5 million is over the four years. Is that correct?

Ms Cole : Yes.

Senator SIEWERT: I'm happy for you to take this on notice, because we all have a lot of questions in this outcome or area. Can you take on notice how that will work? My calculation is that's around a bit over $2.5 million a year for what that support looks like?

Ms Cole : Yes. We'll take that on notice and give you a bit of a breakdown, because those were fairly complicated discussions with beyondblue.

Senator SIEWERT: If you could take that on notice. I heard what you said about state and territories coming on board; I would think, given the nature of this program, they're essential. Have you got them on board already? If they don't get on board, does that mean the state and/or territory misses out?

Ms Cole : So in this particular case, it's not a matched funding requirement. It's seeking co-contributions from the states and territories. Both the Northern Territory and the ACT are already involved in providing these services.

Senator SIEWERT: So, if they don't throw money in the intention is to roll it out across the country?

Ms Cole : To 25 PHNs.

Senator SIEWERT: How many PHNs have we got?

Ms Cole : Thirty-one.

Senator SIEWERT: All right. So, why aren't we doing it for the other—

Ms Cole : Because some of the regions already have this in place.

Senator SIEWERT: They're already providing the service, so other regions that don't are now getting this funding?

Ms Cole : That's correct.

Senator SIEWERT: Are you providing funding to those other six in a separate program?

Ms Cole : We already provide funding to all PHNs for suicide prevention, and some of them have chosen to work with their states and territories to provide aftercare-type services post a suicide attempt.

Senator SIEWERT: Do you not expect them to come back and say, 'Hey, you're giving them extra money'? We've been talking about this aftercare for a long time, so it seems to me that this is an essential funding program, but some have done the right thing and started already, have been forward-thinking or whatever and are already funding this.

Ms Cole : I'm sure there'll be some robust discussions in the future around some of these issues.

Senator SIEWERT: Gee, if I was running one of them I certainly would be. I've got lots of other questions, so I hope I'll get another go, but I did want to go to older Australians' mental health, on page 117—the provision of mental health services in residential aged-care facilities. Can you take us through how that funding is going to be provided? It's not through better access, is my understanding. Can you outline how that funding is then going to be rolled out and how the facility's going to access it?

Ms Edwards : We'll give Ms Cole just a moment's break. It's two measures, as you know. There's $82.25 million to the new mental health services for inside residential care and an additional $20 million for people older than 75 in the community. In the residential care it's going to be done through PHNs so that we can design services that actually meet the needs that are particular—and they might be very different needs—to people with mental health issues in residential aged care. We're just at the beginning of that development, working with PHNs as to what sorts of services might roll out in their areas to residential aged care. It might be that they differ between regions. We're going to make sure that they're talking to one another, so we're sharing learnings and so on. But we also want to foster innovation and for people to respond to exactly what it is that's happening in residential aged care in their area. I think that will be an important discussion that we're going to kick off very quickly.

Ms Cole : That's correct. We'll have a discussion with both the national mental health stakeholders and the national aged-care stakeholders to set the parameter. And then at a local level the PHNs will be responsible for having a discussion with particular service providers, including the aged-care service providers.

Senator SIEWERT: Specific programs then will enable some early intervention processes, and if people actually need mental health direct support services they can access those as well through this funding?

Ms Cole : Yes. The PHN can provide, in essence, the gamut of care. It might be that in a large nursing home you want to do some group work with counsellors around grief and grief resolution as a kind of preventive measure, but you may also be directly providing psychologist services for individuals who have a more severe condition.

Senator SIEWERT: With all due respect, I get nervous when I hear, 'you may'. Will every resident in an aged-care facility who needs individual counselling or mental health support services through this program be able to access them, wherever they are across Australia?

Ms Cole : I'm not sure that we can guarantee that everybody will get exactly what they need at any one time, as we'd have difficulty doing that with the mental health system per se. For example, if you're in an aged-care facility in Derby you may not get as timely care as you would in Perth.

Senator SIEWERT: I appreciate your point, if there's not, say, a psychologist in town or whatever. Previously we've been talking about why people couldn't access Better Access, where you can get individualised support. I understand that the government's gone down this route. But, under that program, if for example you'd gone with that program, people could have been able to access those individual supports. What I heard you saying is that, depending on what the PHN decides—

Ms Cole : No, it's needs based.

Senator SIEWERT: Okay. So the PHN does not have a choice. If somebody needs some of those individual support services, they will be able to access those?

Ms Cole : The idea is that the services provided by the PHN for the general public will become available to those in nursing homes on a basis of need, in residential care. They're constructing basically a step-care model based on need, and that will become available in the residential care. So there are some significant advantages to that. For a start, Better Access is very provider driven in terms of access to services, as you know. So what we want to do is essentially load the rural and remote PHNs again to help them get around that problem. The other advantage is that you can offer that range of services and a range of service providers according to the needs of individual residents within a facility. That's the logic, I guess, in a sense. So, if you take your analogy further, under Better Access, you can only access up to 10 individual services. There is no cap on a PHN service.

CHAIR: Is that a natural break point for you, Senator?

Senator SIEWERT: I wanted to ask about mental health nurses and then that's a natural break. So then, for the other part of the program, that's also funding that will go to PHNs?

Ms Beauchamp : Community based?

Senator SIEWERT: Community based.

Ms Beauchamp : It won't go to the PHNs.

Senator SIEWERT: So how's that going to operate?

Ms Beauchamp : I think we're looking at the Australian College of Mental Health Nurses and initially conducting a trial on the rollout of those community based services.

Senator SIEWERT: With the funding that's been made available, they'll operate on a trial basis?

Ms Beauchamp : Yes.

Ms Cole : Yes. So they've got two years to do a trial, because we're not sure entirely what the best approach is going to be in this area. What we're trying to address are the issues around isolation, loneliness and mental health. And then, after that, in years 3 and 4, there's further funding already provisioned once we actually know what the model should be.

Senator SIEWERT: Okay. Presumably, you're working closely with them for a pilot?

Ms Cole : Yes.

Ms Beauchamp : To commence in January 2019. So we're working closely with them.

Senator SIEWERT: So next estimates we'll be able to ask you questions about progress on the development of that pilot?

Ms Edwards : Yes, you will.

Ms Beauchamp : One month after they start.

Senator SIEWERT: Yes, but by then you'll have worked out—

Ms Cole : The shape.

Senator SIEWERT: With all due respect, I do understand what you're saying, but the point I'm making is I want an understanding then of the model that you've worked out. I appreciate it's probably a bit early for me to be asking those questions now, but I do want to be able to find out more once that's developed.

Ms Edwards : We'll welcome your questions at any time, Senator.

Senator SIEWERT: Thank you.

Senator DODSON: I'm interested in the nexus between the social determinants of health and the programs in the sphere of suicide prevention. Given that there's a debate, as you know, on remote housing going on and the reduction of funding to that, the impact of these social determinants is somewhat critical to this. So do you have a discussion, a dialogue, around that?

Ms Edwards : You're talking in particular in relation to Aboriginal and Torres Strait Islander people, Senator?

Senator DODSON: Yes, I am, particularly in Broome, or the Kimberley would be even better.

Ms Edwards : Can I first say that I'm at a bit of a disadvantage because all of my Indigenous Health team are not here today, because they were here last Friday. But we can answer the questions to some extent and take on notice questions what we can't answer. Of course, the social determinants of health, whether it's mental health or any type of health issue for the whole population and for Aboriginal and Torres Strait Islander people, are a key thing. For the Indigenous-specific suicide prevention trials in the Kimberley and in Darwin, it's really at large for those groups to talk about what it is they need to think about in order to reduce suicide rates there. That would include a range of potential issues as well as service delivery.

As the Department of Health, we jealously guard our health related money to make sure we're actually delivering all the clinical services and health related services that we can, but we interact closely with the state and territory governments and with other parts of the Commonwealth in the suicide prevention space, generally, to try to make sure we leverage as much as we can and factor those things in. We do it in mental health and we do it in the full range of primary care that we roll out for Aboriginal and Torres Strait Islander people. You would be aware that there's a long discussion going on at the moment, very much aligned with the Closing the Gap Refresh about the social determinants of health. That was something that came out of the health plan, and there was a big consultation late last year and a report that was released by Minister Wyatt late last year. We're continuing that discussion in relation to mental health and broadly.

Senator DODSON: I got the impression from my last attendance at the Broome suicide forum that there was a bit of a tendency for people to remain siloed in their approaches to the central objective, if I can put it that way. Is there evidence that this is breaking down and there's some commonality towards an agreed plan and strategy that's taking place?

Ms Edwards : Siloed policy in program areas has long been a problem for governments of all types across all sorts of policy areas, including this one. It's certainly something that we are committed to breaking down and working across. Siloed approaches don't work. It's hard to do. It's hard for government to do, but also, often, organisations who've been doing great work in a small area for a long time find it hard to look across. It's something that we bring together across disciplinary-type forums to try to do. Is there evidence that it's working? I hope we're making inroads into this sort of attempt. We're certainly going to keep at it and would welcome input from you or anyone else about how to do it better. But it's a long road and a difficult thing to do. Government is designed in silos, and we have to work hard with our colleagues to break across them.

CHAIR: Before we go to Senator O'Neill—it might be better to go to Senator O'Neill after the break—Senator Steele-John has to be elsewhere after the break, and we are as flexible as we can be in this committee. He has just three questions on health workforce. Do we have officers in the room who could just quickly see if they can answer those questions or, if not, take them on notice?

Senator STEELE-JOHN: Thank you very much. How many licensed medical professionals are registered with AHPRA?

CHAIR: Senator Steele-John has indicated if you need to take this on notice you may.

Senator McKenzie: We might have found the right table.

Mr Hallinan : In 2016, there were 106,634 total registered medical practitioners.

Senator STEELE-JOHN: Are there updated figures for 2017 or 2018?

Mr Hallinan : No, we don't have those figures yet. We get the data on this through the health workforce survey that is completed as part of medical registration processes through the Medical Board of Australia. The next update to that will be in the next six months or thereabouts.

Senator STEELE-JOHN: Of that number, can you tell me how many identified as having a disability?

Mr Hallinan : I'm afraid we don't collect that information, or that information isn't collected through the data workforce survey, so we don't have data on that.

Senator STEELE-JOHN: So you can't even take it on notice, then?

Mr Hallinan : I can seek through the Medical Board whether they do have any source of information for that, but the advice I have at this stage is that it's not information that they've collected through the survey.

Senator STEELE-JOHN: Is there any other time at which we gather information on that area, or is that it?

Mr Hallinan : Not that I'm aware of. It's usually information that's collected by employers. As a department, we don't employ the medical practitioners and we don't have a management role with the Medical Board either. But I'll take it on notice and will see what we can find.

Senator STEELE-JOHN: Fantastic. Would you also be able to tell me if you record information so that we could obtain a gender breakdown? Surely you do that.

Mr Hallinan : Yes, we will have a gender breakdown. I'll just have to find it.

Senator McKenzie: One of the keynote speakers at the rural doctors conference in Creswick earlier this year, Dr Eeman, is specifically focused on this issue. He might be someone, if this is an area—

Senator STEELE-JOHN: Yes. I'm working with group called Doctors with Disabilities. These figures are available in the United States. They collect the relevant data. I'm just trying to ascertain the percentage of our overall medical practitioners who identify as having a lived experience with disability. It's two per cent in the US, so I'm trying to get an idea.

Mr Hallinan : Senator, I do have the percentage of female practitioners. It was 40.7 per cent in 2016.

Senator STEELE-JOHN: All right. So you don't have a tick box, or a whatever, for disability or any other identities or types?

Mr Hallinan : No. The advice that I have is that there is no question asked in the workforce survey on disability.

Senator STEELE-JOHN: Could I ask you to consider that and maybe include it in the one you are undertaking in six months time?

Mr Hallinan : Yes, we can certainly raise that with the Medical Board, but they are an independent agency. They're not an organisation associated with the department and it's not a survey that the department administers or runs. But it's certainly something that I can take up with them.

Senator STEELE-JOHN: Thank you very much. That's much appreciated.

CHAIR: On that note, we will, I think, go early. You may have the call after the break.

Senator O'NEILL: I've just got one question to clean up the last part. Then I'll have more when we come back.

CHAIR: That's fine.

Senator O'NEILL: I was thinking about the question that I asked with regard to the minister making the announcement—

CHAIR: I think we're back to mental health.

Senator O'NEILL: Yes, about the extension to the trial sites. That was made shortly after the budget.

Ms Beauchamp : The 14th—yes.

Senator O'NEILL: Was that based on advice from the department? Why did this not come out as a budget announcement but it was announced a week later? Can you shed any light on that?

Ms Cole : It wasn't a budget decision. It would be unusual to include it as part of the budget announcements, as a result.

Senator O'NEILL: When I come back, I'll have questions about the whole quantum that was allocated in the budget. A whole lot of bits are in it like this and they are just going to be randomly announced, I assume.

Senator McKenzie: No. I think the department's being quite clear. It wasn't part of the budget. It was a decision made by the minister.

Ms Edwards : The budget measures that appear in Budget Paper No. 2, the part of the budget in relation to mental health, add up to the $338 million, but there is also the $800-odd million a year already in the forward estimates and decisions are made on a rolling basis about allocation of funds from those and they're announced from time to time.

Senator O'NEILL: From the $856 million?

Ms Edwards : I think it was $865 million. But it's the money we were talking about before. It's an existing program, which is already in the forward estimates, and decisions are made, as they are in all programs from time to time, by ministers, and this was one of those. It was made around the time of the budget. It was announced on 14 May. We've taken on notice when the advice was provided in relation to the potential extension.

Senator O'NEILL: So when you said, Ms Beauchamp, that you gave advice to the minister around this as part of the budget process—

Ms Beauchamp : I think I said I'd take it on notice in terms of when we provide the specific advice about the use of funds, and I was speaking in a broader context about the use of funding more broadly in budget processes.

Senator O'NEILL: Not this particular program?

Ms Beauchamp : I think the officers said it was from within the existing mental health program and it would have been from uncommitted funds. But, still, we would have given advice to the minister about the use of those funds—yes.

Senator O'NEILL: Thank you.

Proceedings suspended from 16 : 15 to 16 : 30

CHAIR: We will continue with program 2.1, mental health.

Ms Beauchamp : Before we continue: I have specific advice in terms of when we provided specific advice around the suicide prevention trials. It was provided to the minister, specifically on this issue, on 6 March this year.

Senator O'NEILL: Which is quite a while ago.

Ms Beauchamp : Yes.

Senator O'NEILL: And certainly not very long after the evaluation committee was established?

Ms Beauchamp : That's right.

Senator O'NEILL: So, the data that you used to deliver that information on 6 March would primarily have been from phone conversations with PHNs and from correspondence received from Labor senators and members?

Ms Cole : And our own advice and the advice of the Black Dog Institute. I will check whether we ever got anything in writing.

Senator O'NEILL: If you could trawl for anything that you did get in writing from any of those agencies, I'd appreciate that. Thank you for getting back to me. How much money was allocated to mental health in the 2018-19 budget?

Ms Edwards : Are you talking about new measures or overall?

Senator O'NEILL: Give me overall and new measures.

Ms Edwards : So, you're after 2018-19?

Senator O'NEILL: Yes.

Ms Edwards : In 2018-19, the mental health program is $856.4 million. The additional budget measures are $338.1 million. I don't know if I have 2018-19. There are large amounts of money allocated to both MBS mental health related services in 2017-18. That was $1.2 billion. PBS prescriptions for mental health related illnesses was about $500 million. This is in addition to, obviously, our share of hospital funding for mental health services. And there is also research. The total annual approximate expenditure by the Australian government on mental health is $4.2 billion—

Senator O'NEILL: Before you go to that, hospitals and research—you've given me the names; can you give me the breakdown?

Ms Edwards : In terms of research split between the NHMRC and the National Mental Health Commission, there was $79 million. This is for 2017-18. It takes a total in 2017-18 of $4.275 billion. In relation to 2018-19, which was your question, I haven't got that whole wrap-up number, but the mental health program is $856.4 million. It's in addition—am I right?—to the $338.1 million budget measures.

Ms Cole : No.

Ms Edwards : That includes it?

Ms Cole : Yes. That will include that year's worth of those.

Senator O'NEILL: Could you clarify what you were saying then?

Ms Edwards : It's $856.4 million in 2018-19 for mental health programs through the Department of Health. That includes that year's allocation of the new budget measures, which were announced this year in the budget.

Senator O'NEILL: It includes the $330 million?

Ms Edwards : It includes the portion of that $338.1 million, which is attributable to that year.

Senator O'NEILL: Which is how much?

Ms Edwards : $43.2 million.

Senator O'NEILL: How much was allocated in the 2017-18 forward estimates for the 2018-19 year? Is this an increase of $338.1 million in mental health funding?

Ms Beauchamp : That's a figure over the forward estimates and beyond, because of the research component, which goes longer than the forward estimates.

Senator O'NEILL: Can you sense what I'm looking for? A clear and concise breakdown.

Ms Cole : The budget measures for mental health, which make up the $338 million that we're referring to, largely stretch from 2017-18, because there were a few things which were funded this financial year to 2021-22, the end of the forward estimates. However, there is a big component, which is 2022-23 to 2026-27, that is to do with mental health research, the Million Minds mission.

Senator O'NEILL: How much is that?

Ms Cole : That component is $62.5 million for that period.

Senator O'NEILL: For 2022-27 or in two separate amounts?

Ms Cole : From 2022-27. The total value of Million Minds is $125 million over the 10 years. It's 12.5 million provided annually. I actually led my boss astray—

Ms Edwards : I was happily right the first time! The $856.4 million is before the budget measures for 2018-19. To that, you need to add $43.2 million, which are the new budget measures attributable to 2018-19, which gives you a total of about $900 million.

Senator O'NEILL: Can the department provide the total amount of funding for mental health services in the 2017-18 budget as a total, and what was allocated for each year over the forward estimates?

Ms Edwards : 2017-18? Last year's budget? It's in the budget papers.

Ms Cole : It is in the budget papers. I don't have the year-by-year breakdown with me, but I can probably get it for you over the course—

Senator O'NEILL: You can take that on notice.

Ms Edwards : It would have been in last year's budget papers. We've obviously updated.

Senator O'NEILL: Can you do that for this year in the same way?

Ms Cole : I think we've just gone through that, but we can go through it again if you'd like.

Senator O'NEILL: If you can put the two years next to one another for comparison, that would be really good. Has the department allocated any amount of funding to mental health past the forward estimates? Any of that $33.1 million?

Ms Edwards : Yes. In relation to the research proponent, the Million Minds Mental Health Research Mission is a 10-year mission. That goes beyond the forwards.

Senator O'NEILL: To 2022-23 and 2026-27?

Ms Edwards : It goes to 2026-27.

Senator O'NEILL: And that's a total of $125 million?

Ms Edwards : That's correct.

Senator O'NEILL: How much will be spent, and in which year will you expect that money to be spent or allocated?

Ms Edwards : For Million Minds?

Senator O'NEILL: Yes, the additional funds.

Ms Edwards : It's allocated as $12.5 million per annum starting in 2017-18.

Senator O'NEILL: Of the additional $43.2 million for this year, what's the allocation breakdown for that?

Ms Edwards : This is for 2018-19. For improved access to psychological services for older Australians in residential care there's $7.8 million. For mental health nurses supporting Australians over 75 years there's $0.8 million. For strengthening the National Mental Health Commission there's $3.2 million. For after-care following a suicide attempt there's $6.5 million. For Lifeline Australia for enhanced telephone crisis service there's $6.1 million. For funding for Head to Health there's $2.1 million. For funding for the Junction Clubhouse there's $0.3 million. For the suicide prevention campaign there's $1.2 million. For the Million Minds Mental Health Research Mission there's $12.5 million. For mental health outreach through the Royal Flying Doctor Service there's $2.8 million.

Senator O'NEILL: And the total of that?

Ms Edwards : $43.2 million.

Senator O'NEILL: Do we have the same breakdown in the forward estimates for the following year?

Ms Edwards : Yes.

Senator O'NEILL: The same projects?

Ms Edwards : Yes.

Senator O'NEILL: How much are we talking there?

Ms Edwards : One is a zero number, but we will get to that. This for 2019-20. For improved access there's $16.5 million. For mental health nurses there's $1.1 million. For the National Mental Health Commission there's $3 million. For suicide after-care there's $8.5 million. For Lifeline there's $6.1 million. For Head to Health there's $2.7 million. For the Junction Clubhouse there's $300,000. The suicide prevention campaign is one year only, so that's a zero figure. For the Million Minds Mental Health Research Mission there's $12.5 million. For mental health services through the Royal Flying Doctor Service there's $5.8 million. That's a total of $56.4 million.

Senator O'NEILL: For 2020-21?

Ms Edwards : For improved access there's $26.4 million. For mental health nurses there's $8.9 million. For the Mental Health Commission there's $3 million. For suicide after-care there's $10.6 million and for Lifeline there's $6.1 million. There's no allocation for Head to Health. It's two-year funding has been provided. There's no funding for the Junction Clubhouse and none for the suicide prevention campaign, which was for one year only. There's $12.5 for Million Minds mission and $5.8 million for the Royal Flying Doctor Service. That's a total of $73.4 million.

Senator O'NEILL: And the last one?

Ms Edwards : For the 2021-22 financial year there's $31.7 million for improved access. For mental health nurses there's $9.2 million. For the National Mental Health Commission there's $3.2 million. For suicide after-care there's $12.1 million. For Lifeline there's $15.5 million. That is a much higher number in that year because core funding that we had previously provided expires, so it reproduces the core funding plus the additional. There's no funding for Head to Health, the Junction Clubhouse or the suicide prevention campaign. There's $12.5 million for the Million Minds Mental Health Research Mission and $5.94 million for the Royal Flying Doctor Service. That's a total of $90.1 million.

Senator O'NEILL: Thank you. Could I just ask a couple of questions around the Million Minds project?

Ms Edwards : Yes, although, because it is an MRFF project, my staff may have to take some of those on notice because the MRFF staff have returned to the department. But we will do what we can.

Senator O'NEILL: The budget indicates $125 million provided over 10 years, and you have just indicated that that's $12.5 million each year over that period. In the minister's own words:

Million Minds will be looking at a range of areas including eating disorders, suicide prevention, Aboriginal and Torres Strait Islander people’s mental health, depression, anxiety, bipolar disorder, and other areas of critical importance to national mental health and wellbeing.

That was said at the University of Melbourne 2018 Dean's Lecture on 16 May. Please indicate how much money will go to each of these areas of mental health research. The first one was eating disorders.

Ms Beauchamp : It is probably a bit early to do that because, as part of that initiative, the mission was going to be guided by a research road map. The research road map was going to be developed in consultation with researchers, clinicians, consumers and co-funders. But it was also looking at the umbrella of the fifth mental health and suicide prevention plan, consistent with the Australian Medical Research and Innovation Strategy 2016-2021. So, whilst all those areas have been identified, the actual disbursement and the money to be allocated will depend on the development of this road map.

Senator O'NEILL: People in the sector are already banking on these commitments having been delivered, and they're pretty keen to find out how much they've got. I think they would be pretty disappointed that there is no clear policy at this point in time. What is the research road map? You said it 'was' to be guided? Is it still to be guided?

Ms Edwards : Yes, it is.

Senator O'NEILL: And there is the umbrella of the fifth mental health plan. What is the funding timeline for the release of the first $12.5 million, and how will these very important sectors of the mental health tapestry engage in securing funding?

Ms Edwards : As an MRFF program, it will follow the process we were discussing this morning. Dr Hartland might be able to help us out. The priorities are set by the priorities for that program, and then the program is developed in consultation with experts and so on and there will be a competitive element to make sure we get the best projects for the money available. Dr Hartland, did you want to comment?

Dr Hartland : Sorry, Senator; I was out of the room when this was raised.

Senator O'NEILL: Are there priorities among the priorities? Is there any direction that's been set yet? Is it possible that bipolar disorder might not get anything in the road map until the 10th year? Is that possible?

Ms Edwards : I couldn't comment at all on what will be in the road map.

Senator McKenzie: That's a hypothetical. I think it's unfair to the officials to take guesses at what may or may not happen over the next 10 years.

Senator O'NEILL: I think it's nowhere near as unfair as it is to the sector, who have no idea about when this money's coming through or who might get it.

Ms Beauchamp : I think there's a commitment. It's talking about new research, and there's a commitment to work with and consult with researchers and clinicians and the like, so in a sense it's developed in collaboration with all those people that are relevant.

Senator O'NEILL: Dr Hartland?

Dr Hartland : To reiterate what Ms Evans and the secretary were saying, the government's recently announced the MRFF commitment. We're going through a process of consultation to work with the sector to develop up the research. I think that, if the government had just put flat on the table the precise areas and conditions that it wanted to research, we'd have another problem, which would be lack of consultation. With all of these MRFF programs, there's a commitment to make sure that we engage properly with the sector and to work through what the most productive research questions to pose are, and that's where we are with the mental health.

Senator O'NEILL: There are likely to be priorities among the priorities. If I read this list, are these in any particular order: eating disorders, suicide protection, Aboriginal and Torres Strait Islander people's mental health, depression, anxiety, bipolar disorder and other areas of critical importance to the national mental health and wellbeing? They're not in alphabetical order. Is there any order amongst that? Are there priorities amongst the priorities?

Ms Edwards : I think we'll be taking advice from researchers and other experts on how the road map should fit together. That's the purpose of developing the road map: to see which and in what order and how. Some of these things may be dealt with together; some separately; some sooner and some later, depending on the quality of the research and what the sector say. It's certainly not for us to set those priorities in advance of those processes.

Senator O'NEILL: So it is possible that suicide prevention might have no further funding for many years?

Ms Edwards : We'd expect the road map to deal with all of the priorities that have been identified and sort them and allocate them as is best to get the best level of research.

Senator O'NEILL: Or eating disorders could be waiting for many years before they actually get to a priority level for the road map?

Ms Beauchamp : This is only one element of mental health funding that Ms Edwards spoke about. This is funding under the MRFF, which is really focused on translation research. It will be looking at helping and assisting patients, particularly around new research, diagnosis and treatment. I think it will depend on what the clinicians and researchers say but also perhaps the readiness of some of that research to be applied over the next 10 years. It's a good time frame in which to do it, but this is only one area of mental health funding that's looking at those sorts of issues.

Of course there's other program funding. There's NHMRC funding that's applied to mental health as well, so that also needs to be taken into account. That's looking at—I think Ms Edwards said it was—$79 million worth of research applied in 2017-18 under other programs outside the Million Minds.

CHAIR: With all due respect, Senator O'Neill, you are verging on the seriously hypothetical here.

Senator O'NEILL: I don't think it's hypothetical that, of the research money that's going into the NHMRC, there's a very, very small proportion going to mental health and an even smaller proportion of that going to things like eating disorders and anxiety, which are affecting our young people. I'm interested for people to find out.

CHAIR: That wasn't the burden of the question you asked before, but please continue.

Senator O'NEILL: What will the process be? What will the consultation look like? I'm hoping it won't be like the consultation around the PHNs and the suicide prevention extension.

Ms Cole : The minister had a roundtable in Parliament House a couple of months ago, on 5 March, in which he had a number of very prominent researchers in this area. Also the NHMRC attended, as did the department, largely as the support function. From that, an initial draft road map was developed by the department. It was presented to the minister for consideration.

The minister then consulted with four prominent professors in this area to refine it a bit more because he felt it needed a little refinement before it is sent out to the wider group of stakeholders, researchers primarily and also the major mental health stakeholders, for a further consultation on the roundtable. He's also indicated that he will have an advisory group. He's indicated four members. I'll just turn to my colleague to tell you who those are.

Ms Wood : As Ms Cole says, the minister's yet to establish the advisory panel and confirm its role, but that will be associated with the road map that's going to go out, we expect, this week for consultation. The four members are Professor Helen Milroy, Professor Shitij Kapur, Professor Patrick McGorry and Professor Tracey Wade.

Ms Cole : Those are the four members that are currently known and identified by the minister.

Senator O'NEILL: They will be the only members of the advisory group?

Ms Cole : No, I expect it will be wider than that, but those are the members he announced recently at his presentation to the University of Melbourne.

Senator O'NEILL: How many others have you recommended should be on the advisory group?

Ms Wood : We haven't yet got that far. The minister has a number of people whose involvement in the panel he's interested in our exploring, but he's yet to establish the panel and its terms of reference and the number of advisers that would be part of that panel.

Senator O'NEILL: Are you able to advise the details of the attendees at the roundtable that was held on 5 March?

Ms Cole : Yes. We'll take that on notice.

Senator O'NEILL: Thank you very much.

Ms Cole : It was about 25 different individuals.

Senator O'NEILL: Is the initial road map available?

Ms Cole : It will be available around the end of this week.

Senator O'NEILL: The four prominent professors that you referred to at that point—are they the four that have been named?

Ms Cole : Yes.

Senator O'NEILL: On what date was it that the initial road map went to the minister?

Ms Cole : We might have to take that on notice because I can't remember off the top of my head.

Senator O'NEILL: Thank you. Could you give a list of the researchers and stakeholders that you're consulting with.

Ms Cole : Yes.

Senator O'NEILL: Thank you. Could I go to the Mental Health in Education initiative. You answered a question on notice for me, SQ18000330, where I was asking about how much money has been allocated to the evaluation of the national education initiative. Based on your answers, I've got a series of questions.

Ms Cole : We'll just find that question.

Senator O'NEILL: Senator Dodson has a question that's related to the Million Minds, I think.

CHAIR: Sorry, go ahead.

Senator DODSON: How do you set your priorities within the First Nations domain when it comes to health or the dimensions of health that you cover here?

Ms Edwards : In relation to mental health?

Senator DODSON: Mental health and any sort of health that you do—whatever funding you provide to whomever to do something.

Ms Edwards : Again, Senator, I'm home alone on this one, as my Indigenous team are not here, but let me at least provide a broad answer. Firstly, we have the $3.9 billion over the forward estimates which is the Australian Indigenous health program. About half of that fund is primary care through the Aboriginal-controlled health sector, and then the balance of the funding goes to a range of things: eye health and ear health, which were featured in this budget, and programs to tackle smoking. There is also a significant amount of funding which is provided for mental health programs for Aboriginal and Torres Strait Islander people. That's provided through the primary health networks, although quite a lot of that funding then reverts back to the Aboriginal-controlled network to provide services.

That's the core Indigenous-specific health funding, but that is not the sole priority for Aboriginal health initiatives through the Australian government, let alone through all governments. Obviously, one of the key things we need to do is make sure that the MBS and the PBS, the mainstream programs, are appropriately targeted to fund services for Aboriginal and Torres Strait Islander people. Also, in our hospital funding, we make sure that the way we fund states for hospital services takes account of the needs of Aboriginal and Torres Strait Islander people. In addition to that, we work with states and territories, who obviously have a big role in this field. Across all of that, which is the health funding across the whole of the Australian governments, we then try to link that back in with Aboriginal and Torres Strait Islander affairs and spending generally to make sure that we actually hook in—as we were talking about before—where there are social and cultural determinants of health, so that the other areas of government programs align, because obviously, in an isolated way, health programs are not going to be sufficient to really close the gap on life expectancy or any of the other key measures. All of those priorities were initially set, obviously, by COAG, and then we have complicated processes by which underlying priorities are set, both across the whole of government and then within the health program, both across the whole of the department and within the Indigenous health program. The priorities there are, of course, making sure we have effective primary care and that we tackle chronic disease, and maternal and child health is another key priority. Those are set by government but very much in consultation with the sector, with the community and across all of governments.

Senator DODSON: Can you tell me how many First Nations people you've got employed in the department?

Ms Edwards : About 2.7 per cent, I'm told. Our corporate people may still be here to tell us the exact numbers. In fact, the secretary probably has the number here.

Senator DODSON: Maybe you could give that to me on notice. Coming back to the research stuff, what role, if any, does the Lowitja Institute play in providing advice, guidance and direction, or even undertaking research?

Ms Edwards : The Lowitja foundation is a premier institution for whom we have enormous regard and value. It's currently funded by the department until, from memory—again, I haven't got my full team here on this stuff—June 2019, and we're currently considering funding options into the future. It conducts research and also provides invaluable advice, and we treat it as a very valued and important stakeholder and contributor.

Ms Beauchamp : Of those that are self-identified as Aboriginal or Torres Strait Islander workforce in the department, as at 30 April we have 2.9 per cent.

Senator DODSON: What's the number? I don't know what your total workforce is, so I can't work out the number.

Ms Beauchamp : Oh, sorry. It's 2.9 per cent—I'll have to work it out myself—of around 4,400.

Senator McKenzie: A lot.

Senator DODSON: The minister says it's a lot, so I presume that's a lot!

Senator McKenzie: I can do the maths: 2.9 per cent on 4,000. I'll do that while you keep talking.

Senator DODSON: Okay. I can do that as well, but I haven't got a calculator.

CHAIR: Just before we move on, I did have some questions about the Million Minds Mission, most of which you've answered. But, just to be clear, it's basically a research-driven project; it's not about delivering services on the ground. It's about doing the basic research.

Ms Edwards : It's about research but also about translational research. It's a collaboration between the mental health part of the department and the MRFF teams, and it does fit into that idea of: let's find the causes and treatments and so on for particular mental health disorders and how we actually best put that into practice. So it's not about providing clinical services, but it's about researching the whole pathway to make sure that we can get from great ideas that our Australian researchers might have, find them out and put them through the entire pipeline to actually then deliver on-the-ground treatment and services. But it doesn't fund those treatments and services—that's at the other end.

CHAIR: Just to be clear, what input are you having to the project—the Million Minds Mission?

Ms Edwards : It's funded from the MRFF.

CHAIR: Yes, I got that.

Ms Edwards : And the mental health teams will be working on preparing the beginning of that road map. Then the MRFF will have regard in terms of its priorities and so on as well, the two things will come together and the funding will flow to researchers.

CHAIR: Great, thank you. I just wanted to clarify that.

Ms Beauchamp : Just to respond to senators in terms of numbers in the department, it's around 125.

Senator DODSON: So 125 out of 4,000?

Senator McKenzie: It was 4,282.

Senator O'NEILL: Could I just ask: why is the Mental Health in Education initiative an 'opt in'? Why isn't it mandatory, because we know that mental health issues are happening in every educational site across the country?

Ms Cole : Senator, that's to do with a constitutional issue around the states and territories controlling education. We're not able to dictate to them that they use a particular program or whatever. But this program is well respected. It's based on Minds Matter and KidsMatter, which have been in a large major of schools across Australia for some time. So we're not anticipating that we'll have some issues around acceptability of the new, revised program.

Senator O'NEILL: What work are you doing to ensure as many schools as possible participate?

Ms Cole : So beyondblue have indicated they believe they'll be able to double the number of schools participating over the period. I'll just turn to my colleague in terms of the actual numbers that they're indicating.

Ms Wood : They're aiming to reach about 6,000 schools nationally in the first year of the program, which is expected to commence in August this year.

Senator O'NEILL: Is the department confident that this can be achieved?

Ms Cole : We're pretty confident because of a couple of reasons. One is that beyondblue were already running those programs before they were revised and vitalised and they already had a fairly good reach into schools at that point. The other reason is that they have done a huge amount of work, consulting with the state education departments and the schools themselves in order to make sure there is a high acceptability of the new program.

Senator O'NEILL: How similar to or different is it from the Minds Matter and KidsMatter programs, which had pretty amazing coverage across the country?

Ms Cole : Essentially, KidsMatter and Minds Matter and then some work that was done around early childhood were all developed at slightly different times. KidsMatter had been around for 15 years or something like that—we can check that for you—and Minds Matter was a later version developed by a different organisation. We've asked beyondblue to make sure that the program is cohesive from the early childhood right through to the end of high school. It's taking the basic principle of those two programs, which was essentially around assisting teachers to teach basic resilience and other skills—emotional intelligence type skills—as a preventative measure as well as being able to identify at all those different stages, depending on what type of teacher you are, children who may require some additional assistance or showing sciences of perhaps trauma within the family, early signs of mental health, suicidal ideation and all those sorts of things. So it is taking those ideas and ensuring that there's a consistent thread and theme right from the three- and four-year-olds right up to the 18-year-olds.

Senator O'NEILL: How much effort has gone into making sure that the whole school context is part of the framework, because it is not just about information and skilling up; it's about school context?

Ms Cole : Particularly for the high school age children, basically from 12-year-olds and above, there is also a component which is around school support, which is specifically around suicide attempts and suicides within a school community and responding quickly and appropriately to that. Another part of the program is around creating linkages between local appropriate services and the schools, so that the schools are able to refer appropriately to headspace or whatever might be appropriate.

Senator O'NEILL: I will come to some detailed questions about that. Which states and territories are you expecting these services to be delivered in?

Ms Cole : All states and territories.

Senator O'NEILL: Everybody's participating?

Ms Cole : Yes.

Senator O'NEILL: The evaluation that you described doesn't focus on outcomes. Is there a reason for that?

Ms Cole : The one that we've described in the—

Senator O'NEILL: In your QON response.

Ms Wood : We spoke about the two individual evaluations—the one being undertaken for the workforce initiative that supports this, and the education initiative that's being run by beyondblue. They're about design and implementation of those individuals. We're also undertaking an overarching evaluation of the combined that Ms Cole just spoke of. We've just gone out to market for that and we're engaging an evaluator to undertake that evaluation, and that will look at outcomes.

Senator O'NEILL: Outcomes for?

Ms Cole : The whole preventative child support programs—the two major programs that we run.

Senator O'NEILL: Do you have any details about that? If it's gone out to tender I'd say it's reasonably advanced. Would you be able to provide the plan and what you're up to?

Ms Cole : We can provide that.

Senator O'NEILL: Great. In January this year there was an announcement of more funding to beyondblue. Was any of that funding including additional funding for evaluation?

Ms Cole : No, it's service delivery funding on the whole.

Senator O'NEILL: What's the quantum?

Ms Cole : It's up to $23 million per year for an additional two years. However, they are required to do the evaluation as part of the overall grant that they have to run this program, so presumably they'll use a small proportion of that to keep the evaluation running for those extra two years.

Senator O'NEILL: So what's happening with the evaluation if all the money is going to services? Where's the funding for the evaluation?

Ms Cole : I just explained that. We haven't actually contracted this amount with them yet; we are still in discussions with them. The evaluation was part of the overall initial proposal from beyondblue when we went and approached the market. We're expecting that they will continue that evaluation as appropriate over those additional years, but we haven't finalised our grant condition discussions with beyondblue yet.

CHAIR: So they're delivering the program and part of the delivery of the program includes evaluation?

Ms Cole : That's correct.

Senator O'NEILL: And they have been funded already for that?

Ms Cole : Yes.

Senator O'NEILL: To what amount as part of that? Is that specified?

Ms Cole : They have allocated just over $550,000 for the evaluation to date.

Senator O'NEILL: Over what period of time?

Ms Cole : This will be for their initial funding agreement, so the first two years. I'm not expecting that it will cost that much to continue it on for the following two years because essentially, once you've got your parameters in place, you kind of wait for things to happen that you are then evaluating.

Senator O'NEILL: And repeat. I want to take this opportunity to shout out to the 35 headspace centres that I visited around the country and congratulate them all on the amazing work that they do. I want to put on the record how concerned I continue to be about inadequate funding and a failure to index and about the impact that that's having on people working in those services and on continuity of care. If the program that we've just been discussing is successful, there will naturally be a significant increase in the number of students who will be referred to services or encouraged to attend services, particularly services like headspace. You indicated I think earlier this evening that part of the money is to create better linkages between schools and health services that exist in the community. My question really is: how is headspace and other local community services, including GPs, going to cope if this program is successful?

Ms Cole : Part of the success of this program is I guess in a sense preventing children from actually getting the more severe or the more moderate forms of mental illness wherever possible, so addressing issues early. I don't know that you can necessarily draw a direct correlation between the success of this program and an increase in the number of people presenting at headspace. However, having said that, we do appreciate the issues you've raised around capital redevelopment for headspace centres and indexation, and that's something we're working on internally at the moment.

Senator O'NEILL: And they're two separate things—capital funding and indexation for ongoing recurrent needs?

Ms Cole : Yes, and we understand very clearly that they are two separate things.

Senator O'NEILL: Have you got any news for me about that?

Ms Cole : No, I don't.

Senator O'NEILL: Is the minister going to make an announcement next week?

Ms Cole : I don't have any news for you on that. It's an internal discussion.

Ms Edwards : We should put on the record that we do spend $273.6 million on headspace service delivery—that was 2016-17 to 2018-19. As Ms Cole says, we continue to work very closely with services and with the national office for headspace. We also monitor very closely and keep abreast of what's going on. We are very committed to the services and making sure they can cater for the demand. We're watching them closely. We have nothing to inform you of at the moment.

Senator O'NEILL: So can you assure me that students who are empowered to acknowledge that they need some assistance with mental health will find the health care that they need?

Ms Cole : We can't guarantee any particular person any particular service but I can—

CHAIR: I don't think that's the officer's job, but the minister may want to comment.

Ms Cole : We definitely have a strong commitment to the services.

Senator McKenzie: Senator, I think asking the officer that type of question is really just being quite free and easy with this process. She's here to answer questions around budget estimates, not to provide guarantees for your press releases.

Senator O'NEILL: Well, I hardly think that this matter of youth mental ill health and suicide—

Senator McKenzie: Oh no, Senator O'Neill, do not underestimate my concern and intent to address mental—

Senator O'NEILL: It's a lot more important than a press release, Minister.

Senator McKenzie: health issues of students across this country, but—

Senator O'NEILL: So are you going to guarantee that if they need to go and get treatment, that they're actually going to—

Senator McKenzie: choosing to play cheap political points through the Senates estimates process—

Senator O'NEILL: You're a teacher; you know what goes on in these classrooms. You know teachers picking up kids in between classes who need to go and get health care, and they can't get it at the moment.

Senator McKenzie: by expecting the officers of the department to play some cheap political game on your part is ridiculous, and it's continuous. And I'm saying enough.

Senator O'NEILL: There is no cheap political game, Minister, in a student needing—

Senator McKenzie: Enough!

Senator O'NEILL: access to services that your government has failed to fund adequately.

CHAIR: Senator O'Neill, this is not a question.

Senator McKenzie: I'm very proud to be part of a government that's making record investments into mental health services across this country and particularly $110 million for young people across this country—

Senator O'NEILL: Chair, Senator McKenzie cast aspersions on my determination to have these questions asked on behalf of young people across the country.

Senator McKenzie: in January which I'm happy to run—

CHAIR: I think it is very unproductive to talk over each other. So let's move on. I have some questions on beyondblue. Is the funding you talked about in response to Senator O'Neill's question, the $40 million over two years, the only funding to beyondblue in the recent budget? Does that include the Way Back Support Service?

Ms Cole : No, this is separate from the Way Back Support Service.

CHAIR: Can I get an understanding of what the Way Back Support Service is and what it's trying to achieve?

Ms Cole : That's the suicide after-care—

Senator SIEWERT: That's the one I asked about.

CHAIR: I am very sorry; I missed that. If this question has been already been asked and answered then I shall move on.

Senator SIEWERT: Well I knew what it was for. I was asking questions about it.

Ms Edwards : We may have jumped over. So the program is directed to that high proportion of people who've had a suicide attempt and end up in hospital. Many of those people have never had any access to mental health services before—it's their first presentation—and this is a measure to try and ensure that there's appropriate follow-up care. It's something that has been rolled out on a smaller scale to date, and the budget decision was to expand it significantly to work with PHNs, hospitals and beyondblue, to do model fidelity, to make sure that when people come out of hospital after a first suicide attempt—perhaps they've never had any contact—that there's follow-up, because we know that the time that people are at most risk of a successful suicide attempt is immediately after an unsuccessful attempt.

CHAIR: So was this is a national program before or is it—

Ms Edwards : No.

Ms Cole : So beyondblue's after-care program is a little different in that it's actually trying to deal with the social issues that may have encouraged or may have created the situation under which a person felt that they needed to end their life—that they couldn't see a way out. So, for example, if they had a financial crisis, a relationship break-up or similar. What it does is hooks them up with, essentially, a person who can provide that kind of social care and assistance in getting the right services so they can get out of their financial problems or similar, for those three months. An example is domestic violence: there's a strong link between domestic violence situations and suicide. So it's around providing that assistance to smooth over those aspects of their life, which they felt might have meant that they could no longer exist, and to get forward momentum,

That doesn't mean that they don't also need clinical care, and the clinical care is the responsibility of the existing services, whether those are state or whether they are funded by the Commonwealth. You know, for example, seeing a psychologist to deal with depression, anxiety or whatever, which may have contributed. So it's around trying to look at the whole circumstances of an individual and to address those circumstances which drove them at that particular point in time towards a suicide attempt.

CHAIR: It may just be because I haven't been here for an overly long period of time that I hadn't heard of this service. Would it have been operating in Western Australia?

Ms Cole : No, it hasn't been operating in Western Australia. There's been a couple of trials run by beyondblue. One of those was in the ACT, one in the Northern Territory. So those were the initial sites, and then—

CHAIR: So will this funding effectively roll it out nationally? Is that the goal?

Ms Cole : Yes, that's correct.

CHAIR: So they've done the trial. They're now going to roll it out nationally?

Ms Cole : That's right. Some PHNs had already looked at the trial and picked up the service because they thought it was a worthwhile thing to do. And then, essentially, this extends it out to those regions that don't currently have anything similar.

CHAIR: Would this project be tied up in the suicide prevention trials or is it completely—

Ms Cole : It's separate and additional to.

Ms Edwards : Just to give you an indication, I think about 1,200 people have been referred to the service since June 2014. This additional funding will allow support to approximately 28,000 additional people.

CHAIR: You may not be able to answer this, but how does beyondblue go about delivering those sorts of services into rural, regional and remote Australia?

Ms Edwards : Commission specific services that cater for that sort of clientele, working with the local hospital services. Sometimes people from remote or regional areas will have had to have gone to hospital in the city, so there will have to be services that make sure we follow them back home. That's why the PHNs are involved, in order to assess the need and make sure we design and commission services that meet that requirement.

CHAIR: Thank you. Senator Siewert.

Senator SIEWERT: I wanted to go to the issue around continuity of supports. I realise some of this is for you and the rest is for DSS later in the week, but can I ask questions around the bits that belong to you. First off, $92.1 million has been allocated over five years for continuity of supports. Is that right? My understanding is that that is overall for continuity of supports for NDIS.

Ms Edwards : I think that's a DSS budget measure.

Ms Cole : Senator, it is. It's a little complicated. Essentially, there was already funding in the forward estimates for the over 65s for the continuity of support arrangement. This addresses the under 65s. The $92-odd million you're talking about actually covers three programs. Two are ours, which is the day-to-day living and the PIR Program, and the third is the PhaMs program.

Senator SIEWERT: That's one of the things I wanted to clarify. It talks about continuity of supports. Is it just for people with mental illness and psychosocial disability, or is it across other areas as well? I didn't know if you could answer that, so I was going to ask how much has been allocated. Can you tell me how much you've been allocated out of the whole program?

Ms Cole : Our component is the $92 million, I believe, and the remainder of their measure relates to other programs run by DSS. Because it's not our measure, we'll just have to be a little cautious, and you may want to ask about it on Thursday.

Ms Edwards : We're just looking at budget paper No. 2?

Senator SIEWERT: Yes. Is that the extent to which the funding—$29.8, $31 and $30.6 million?

Ms Edwards : Yes.

Ms Cole : Yes. That works out to about the $90 million over the three-year period—90-something.

Senator SIEWERT: That's the issue—it says 'over five years', but from 2017-18.

Ms Edwards : It's only a very small amount in 2018-19.

Ms Cole : Because the continuity of support only applies to people currently in the programs who are not successful.

Senator SIEWERT: I understand that. I'll ask the department about other breakdowns. I want to specifically ask you about the PIR and day-to-day living programs. In terms of the allocation of funding for the programs you have responsibility for, on what basis has it been determined that that is going to be adequate? You've been fairly consistently quoting transition at around 74 per cent. I'm basing this on some PhaMs figures, and I will then ask about day-to-day living and PIR. Based on that, there's nowhere near that level of transition of people moving into NDIS happening.

Ms Edwards : Senator, you will have to follow this up primarily with Social Services later in the week. We work very closely with them, because we want the funding for clients to match the transition, and we're talking to them about that. But all of that projection and working through the numbers and exactly where it's up to—we don't even have particular visibility of exactly who's where in the process, so you really should take it up with them. But I can assure you we're working closely with them to make sure that the funding phasing matches the transition pathway.

Senator SIEWERT: I really don't want to be sent back from them to you, so I'm going to ask you a few more and you can tell me, 'No, go and ask them.'

Ms Edwards : Sure.

Senator SIEWERT: What figures have you provided to DSS to calculate how much funding is needed for continuity of support for Day to Day Living and PIR?

Ms Cole : We use the trial transition rates for our two programs at this stage to work out the continuity of the support requirement.

Senator SIEWERT: So, the ACT?

Ms Cole : Yes.

Senator SIEWERT: Which other trial did you use, sorry?

Ms Cole : And the Hunter-New England.

Senator SIEWERT: Okay. Things have moved on very significantly since then.

Ms Cole : Yes.

Senator SIEWERT: You haven't updated those figures?

Ms Cole : Those are the only ones that we have where we have a full population that's transitioned. That's why we've chosen them. As you know, there is still quite a lot of work to be done, so it's quite difficult to use in-transit populations for those estimations, if you see what I mean. There are many people who've got applications in but have not yet received a full assessment or a plan.

Senator SIEWERT: Yes, I take your point. But, certainly for PHaMs, where I've got the most up-to-date information—because I asked them last estimates—it's nowhere near the 74 per cent transition, and there's more accurate detail there because there are people that have withdrawn their applications or just haven't put any in.

Ms Cole : Senator, you'll have to ask about the PHaMs transition—

Senator SIEWERT: I understand that. I'm using that as an example of where they're up to to basically indicate that those figures are not matching what was originally anticipated and planned for.

Ms Edwards : Senator, I understand your issue and why you're asking us about Partners in Recovery, and Day to Day Living. But, generally, the way the transition works, and the speed of it and how the money matches it, are really matters for DSS, even though their program's transitioning from us. We're working with them with the aim of making sure it is smooth and so on, but they're leading that stuff and have the policy lead. They're no doubt watching, and I'm pretty confident they'll be able to answer your questions and won't send you back to us. That's certainly my hope!

Senator SIEWERT: I'm really trying to get an understanding here. So, you actually don't have line of sight on people transitioning from PIR? You don't actually have line of sight for that?

Ms Edwards : They're definitely the policy lead. They're talking to us about it, but they've got all of that—

Senator SIEWERT: Okay.

Ms Edwards : and they should be able to talk about these programs also.

Senator SIEWERT: Okay.

Ms Edwards : And we'll talk to them in between.

Senator SIEWERT: Are you able to then take it on notice as to how many people are still on PIR—

Ms Edwards : Yes.

Senator SIEWERT: and Day to Day Living that are still receiving funding from those programs? Do you have details on that—either now, if you do, but, if not, can you take it on notice?

Ms Edwards : I don't think we have it here. We can take it on notice.

Senator SIEWERT: Okay. Can I have the most up-to-date figures on how many are still getting funding for Day to Day Living and PIR?

Ms Edwards : Yes.

Ms Cole : Day to Day Living will be tricky because of the nature of the program, but we'll do what we can.

Senator SIEWERT: If you could, that'd be appreciated. Thank you. How much funding is then allocated to that group of people, or will it cost—

Ms Cole : Until full transition, we have the full funding originally allocated for those programs. What the continuity of support is is it's the extra funding required for the under-65s who require funding, whatever—

Senator SIEWERT: Who will require ongoing funding.

Ms Cole : That's right. There's no actual reduction in our allocations, until we go to June 2019.

Senator SIEWERT: Even though some of those people will have transitioned already?

Ms Cole : Yes. There's an in-kind arrangement.

Senator SIEWERT: Yes. That's what I want to know, sorry: do you have the figures for how much now is in-kind contribution?

Ms Cole : To date, the in-kind contribution has been very small. We don't have any figures related to this financial year yet. It's done in arrears as people shift over and then receive services.

Senator SIEWERT: On notice, can you give me whatever figures you've got? That'd be really appreciated. So that's people under 65 who don't transition to NDIS and who need continuity of support who have existing supports.

Ms Cole : Yes.

Senator SIEWERT: I want to go back to the discussion that we had a number of estimates ago and it's been a bit ongoing. What about Those people that would normally have qualified for PIR or day-to-day living, who would normally put in a request or gain support for those programs that don't qualify for NDIS?

Ms Cole : In the future?

Senator SIEWERT: Yes, into the future. There's the $80 million contribution.

Ms Cole : That's correct.

Senator SIEWERT: That's for supporting that group of people. Last time I asked for an update, it was $80 million. Can I ask for an update on that.

Ms Edwards : I think in the last exchange we had on this, I expressed my very keen hope to have it done by these estimates.

Senator SIEWERT: Yes, you definitely did.

Ms Edwards : I did. And I have been making the team work very hard in the interim. So the Western Australian bilateral is signed up and done.

Senator SIEWERT: That's good for my home state.

Ms Edwards : For the other states and territories—

Ms Cole : And South Australia.

Ms Edwards : Oh, and South Australia—hot off the press—is done. In relation to all other states and territories, official discussions are all concluded. We think there are agreements to match funding as content for bilaterals. They have all been approved at the Commonwealth end by the minister, and we're awaiting final approval by state and territory ministers. As far as we are concerned, they are completely done. I had hoped to get more of them back for you today. But we think they're done and they should be emerging very shortly from the other states and territories, and the money will then flow.

Senator SIEWERT: Will there be information available on those agreements? Is that going to be publicly available?

Ms Cole : Yes, they'll be published.

Senator SIEWERT: Once you release them? Will you do them as a job lot or can I go and find WA and South Australia somewhere?

Ms Edwards : I think we'll do them as a job lot.

Senator SIEWERT: In the near future?

Ms Edwards : I expressed my great hope last time and, in the meantime time, we've done everything we can from our end. I've got no reason not to think the other states will quickly finalise it and it will happen very quickly, but we've certainly done everything we can to make it happen really quickly.

Senator SIEWERT: Can I be really cheeky and could you take on notice when they're completed and then make available the agreements?

Ms Edwards : Assuming they're done by the time the date for answers is up, yes.

Senator SIEWERT: That would be appreciated, thank you.

Senator O'NEILL: I have a couple of quick ones. The National Eating Disorders Collaboration's national rollout the workforce capability project, can you give us a quick update on that project and when you expect the rollout to be achieved. I think you were expecting workforce education resources to be disseminated by 30 June. Is that still the date?

Ms Cole : I believe so but I will just ask my colleague. He is nodding.

Senator O'NEILL: Do you want to give me that update on notice or are you able to give me any information tonight?

Ms Cole : My understanding is it's going pretty well. They commenced work on the coordination's identification of gaps in existing workforce education resources. They have done a coordinated suite of existing workforce education resources, which is due to be disseminated by 30 June this year. We have no reason at this stage to believe that that won't happen in that original time frame

Senator O'NEILL: Is it still a trial or has it changed status?

Ms Cole : I don't think this one was every really a trial; it's more like an education project.

Senator O'NEILL: Will each state and territory have access to eating disorder specialists to meet the competencies?

Ms Cole : This is around workforce education—the component you asked about—it's not around service delivery. I mean, it is in the broad, but it's not around creating a new workforce.

Senator O'NEILL: So the issue for rural, regional and remote Australia is access to eating disorder specialists?

Ms Cole : Yes.

Senator O'NEILL: Is there anything being done to that end?

Ms Cole : What this will do is assist GPs and psychologists in those regions to better address eating disorders in terms of services on the ground. For those that are very severe and so forth, there may still need to be referrals into cities, to specialised acute services and so forth.

Senator O'NEILL: So the distribution of the eating disorder specialists really is not being resolved by this—

Ms Cole : No, it's—

Senator McKenzie interjecting

Ms Cole : That's right. It's a workforce education process, so one of the things that the NEDC were saying is essentially that many psychologists, GPs or whatever, when confronted with a person with an eating disorder or a suspected eating disorder, don't feel that they have adequate skills. So this is around that front line and trying to make sure that that front line of services, whether rural and remote or in the city, is better able to identify those emerging problems and then also better able to initiate early stages of treatment.

Senator O'NEILL: Who's providing that training?

Ms Cole : It's around a workforce resource, and then we'll look at a variety of ways to do it. For rural and remote, we often use our mental health education processes with webinars and local study groups and all those sorts of things, which are run through—

Senator O'NEILL: Has anyone been contracted to do this work?

Ms Cole : Not yet.

Senator O'NEILL: How much is allocated?

Ms Cole : We haven't allocated any additional funding at the moment. We're waiting for the resources to be completed and disseminated, then we'll consider whether we need to do anything—

Senator O'NEILL: What bucket of money will that come out of?

Ms Cole : Most likely out of what's called our national leadership fund, which allows us to do these kinds of one-off projects.

Senator O'NEILL: Typically how much would a program like this cost?

Ms Cole : For a variety of work, we provide them about $1 million a year—it goes up and down a little bit.

Ms Edwards : And that's indicative only, Senator.

Senator O'NEILL: Yes, that's fine. I'm just trying to get an indication. You might remember the voluntary industry code on body image that Labor endorsed in 2010. It seems to have disappeared and I couldn't find it online. It was previously located under the office of youth. Does the department know anything about where that code is?

Ms Cole : No, but we can make inquiries.

Senator O'NEILL: I have a few questions for the Mental Health Commission.

Ms Edwards : Are they questions about the Mental Health Commission or of the Mental Health Commission?

Senator O'NEILL: Probably they are the best placed to respond.