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Thursday, 30 June 1949

Mr ACTING DEPUTY SPEAKER (Mr. Sheehy) - Order! The right honorable gentleman's remarks are well away from the subject of the bill. He must confine his remarks to the bill, which relates to medical practitioners.

Sir EARLE PAGE - The bill deals with the matter of prescriptions being written in a certain way. As T have stated, a man on £500 a year will pay £37 5s. in social service tax. If he now belongs to a lodge such a man pays only 3d. a week for prescriptions that are based on the British Pharmacopoeia and the Australia-New Zealand Pharmaceutical Boole. Threepence a week is equal to 13s. a year, or one-twentieth of what a man earning £6 a week pays in social service tax. The great, bulk of lodge patients are in the income groups [ have mentioned. As all the electors are not .fools, it is the realization of this discrepancy, first of all in the greater opportunities of obtaining medicine and. secondly, in the lower cost, that makes the Government's gr,heme of very little interest to the 2,000,000 voters in these income groups. Under this measure the position will apparently be that it will not be competent for the doctors of this country to prescribe on a government prescription form as wide a range qf drugs as they can prescribe for a lodge patient who pays 13s. a year. The bill also provides that if a doctor prescribed a drug in the formulary on his own prescription form, instead of on the govern ment form, he is liable to a fine of £50. Could anything more stupid than that be imagined ? That is why the people are not interested in the Government'* scheme.

Mr Thompson - How much would a lodge patient pay for an injection of penicillin?

Sir EARLE PAGE - I understand from the Manchester Unity Independent Order of Oddfellows in Sydney that that friendly society has made arrangements for chemists to provide penicillin.

Mr Thompson - But not for 13s. a year.

Sir EARLE PAGE - What justification is there for the Government's policy of imposing a savage penalty of £50 on the lodge doctor who prescribes a lifesaving drug under his contract? The only exception, apparently, is when the patient asks for it. 1 ask honorable members to think for a moment of the stupid position that would be created bv this provision. What will happen when a man who' is really sick goes to see a doctor? He may be delirious and the doctor may have to tell him that he has phthisis or some other very serious complaint. That would be a tremendous body blow for a patient. Would such a patient like the doctor to ask him whether he wanted a government prescription that might' do him no good or whether he wanted the doctor to write a prescription that would do him good, on the doctor's own prescription form? Imagine a doctor having to discuss such a matter with such a patient. Let us take an everyday case. A doctor may be called out to a man who has had a stroke or a bad accident. Before he gives him a shot of morphia must he wake the patient up, rub his ear and ask him, "Do you want me to write a prescription on my own form or the Government's form ? " This bill has obviously been drawn up by some one who has never been sick in his life. If the Government had any sort of sympathy at all the measure would not have been introduced into this Parliament. It is a scandal that the people should be made a kind of political pawn. The Government is using this scheme to win votes, but it will not succeed in doing so. The people of this country are awake to what is behind the scheme. The Government could provide free medicine for the people to-morrow if it chose to do so and if the parties at present in Opposition get into power at the next general election they will give the public free medicine. The absence at this stage of the honorable member for Denison (Dr. Gaha), who is the only doctor on the Government side, is very significant. I have not the slightest doubt that for months that honorable member has told the. Labour party what he thinks, as a medical man, of this scheme. He surely has indicated again and again how stupid, silly and cruel it is. Every doctor who has ever thought about this matter thinks exactly as I do and agrees with what I have said about the scheme. I am sure that the honorable member for Denison thinks that the scheme is so stupid that he does not intend to stand f«r election to the Parliament at the next general election. The Minister in his replies to statements that have been made to the effect that the formulary does not include several important drugs, were not in existence when the formulary was first published. As soon as he said that, doctors throughout the country gave instances of cases that had come under their own observation. Dr. O'Reilly, a well-known Sydney specialist in allergy diseases, pointed out that several very important drugs for the treatment of allergies had been omitted from the formulary, although they had been in general use for a number of years. Some of them had come into use in 1938, others in 1941, and others in 1943.

What sort of measure is this that intends that doctors are to be fined for prescribing life-giving drugs? Honorable members have only to cast their minds back to the marvellous progress of modern pharmacy, to appreciate how sulpha drugs were discovered and produced an extraordinary revolution in the treatment of septic diseases, and how penicillin was discovered and saved lives during the war. The progress of medicine is so rapid that the British Pharmacopoeia is re garded as five years out of date by the time it is published, and this formulary is already about ten or fifteen years out of date. I should like to point out that the doctors made a very reasonable proposition to the Government. They said that they were willing to have prescription form's of their own printed in such a way that they would be practically uniform in style and could be easily examined by the authorities. They also said that they were willing to establish supervisory committees' to keep discipline in the matter of prescribing drugs and to deal with any unscrupulous actions that might be damaging to the Government's finances or to the patient himself. This brings us to the real nub of the matter. Any one with any reason at all must realize that the only way in which a worth-while and progressively improving medical' and health service can be obtained is through a willing and enthusiastic medical profession. The aim of the Government seems to be to fix medical treatment and the care of the national and individual health at ifr present static point, or even at a lower point, bv imposing Public Service control. The test of any national health scheme should be its ability to improve the health of the individual patient and of the nation. Doctors have always endeavoured to achieve a continuously progressive higher standard of treatment all the time. This will not be achieved by the bill. We know how difficult it is to stir a governmental agency to action. Will fining a doctor for not using a government prescription form, as is provided in the bill, or the forcing of patients to pay for medicines prescribed on the doctors' own forms, improve the health of the community? Experience shows that such procedure will not improve, but will depreciate the health of the community. A doctor who is treating a patient does not desire to, and should not have to, discuss the question of what form he will write his prescription on. or whether the patient wants to pay for a particular drug. That is not the way to develop a national health system.

Mr ACTING DEPUTY SPEAKER - Order ! We are not now discussing a national health service bill.

Sir EARLE PAGE - We are discussing the question of prescriptions. Surely we are entitled to discuss the question of prescribing compound medicines and other safety medicines for which the Government will pay if the doctor writes his prescription on a government form, or for which the patient will otherwise pay. The honorable member for Reid (Mr. Lang) was Premier of the State of New South Wales and he could tell the House that State authorities can administer health matters much better than the Commonwealth can, because they are nearer to the people. In fact we would get a better health service than will be provided by this measure if local governments were to manage the service. If we examine the position in the States that have been conducting medical services for many years we shall find that, whatever political party happens to be in power, the policy does not change. The building of hospitals and the establishment of clinics and pre-maternity centres continues, because it is the traditional policy. The present Government knows nothing about health, which is why this Parliament is now considering a most contentious method of administering a health service. It is certain that, instead of having a good and continuing health policy we shall have under this measure, a most .unsatisfactory one which will be reversed as soon as there is a change of government. The same electors who elect the members of State Parliaments elect the members of this Parliament. The States have developed a traditional system of dealing with health, and surely the electors want us to adopt the same system. Surely they do not want us to pass a contentious measure like this that will engender bitterness that will last for years and will do no good at all. That is why I say that what we should do is to lay this measure aside, and get right down to the things that really matter, such as the provision of hospital beds.

Mr ACTING DEPUTY SPEAKER - Order! I do not desire to have to remind the right honorable gentleman again that we are discussing the writing of prescriptions, which has nothing to do with hospital beds or anything else of that nature.

Sir EARLE PAGE - If there are no hospital beds there will be few people left to use the Government's drugs, because all will be dead. The question of where the p'atient is treated has everything to do with this matter, and if honorable members will examine the bill themselves they will see-

Mr ACTING DEPUTY SPEAKER - Order! The bill deals with the writing of prescript. ons by medical practitioners.

Sir EARLE PAGE - Surely a man must have a hospital bed if he is to be treated and properly cured. Surely the provision of hospital beds is part and parcel of a national health scheme. If I am permitted to do so, I say that the right thing to do is to repeal this legislation and adopt other legislation and if I am not in order in doing so I shall move an amendment to the bill. It is possible for the Commonwealth to achieve results in some directions. When the honorable member for Warringah (Mr. Spender) was Minister for the Army, he was responsible for the erection of hospitals equipped with 4,000 beds. I suggest that the Government should provide 10,000 or 15,000 hospital beds, and then there would be less need for writing out prescriptions. I urge the Government to co-operate with the doctors, and drop these penal provisions. Those who are accustomed to treating sick people know that they cannot be dealt with by compulsion. They must be cajoled. The Government must surely have some reason for introducing this bill, but no adequate reason has yet been stated. Why is the unfortunate patient to be made a sort of anvil upon which to knock out the brains of the doctors? Why should a sick person he pestered by asking him whether he wants to get his medicine free? The Government is attempting to put economic pressure on the sick in order to force the doctors to accept a national medical scheme. Even if such a scheme were forced upon, the doctors, they could sabotage it by refusing to co-operate.

Mr Burke - Is the right honorable member suggesting that they would sabotage a national medical scheme?

Sir EARLE PAGE - No, because their standard of honour is too high, but they will not work under such a scheme. There is a difference between the doctors, and other members of the community who have gone on strike. Although the doctors disagree with the Government over its medical proposals, they go on treating their patients because they have a sense of honour, and a pride in their profession. Men who behave in that way are entitled to consideration, and the Government should consider them instead of treating them like blackguards, and trying to dragoon them in the manner of a Prussian drill sergeant. Again, I ask, why is the Government bringing in this bill, which one of its Ministers in the Senate has said is unnecessary? He admitted that the matter could be dealt with by regulation. Does the Government want to embody proposals in an act so that, if it is defeated at the next election for the House of Representatives, but still retains the majority in the Senate, another government will be unable to repeal the legislation? Perhaps this would be a good issue upon which to have a double dissolution. Is that the motive behind the Government's action, or is it actuated by sadistic motives? Is its attitude towards members of the medical profession something like this : " You are only doctors. You are not concerned with ordinary events; you are concerned only with treating sick people " ? The Canadian Government has dealt with this same problem in a satisfactory manner. The British Government tried to force the doctors into a certain course of action and its whole medical scheme is falling to pieces. This legislation is of the same provocative order as that under which doctors may be fined £50 for writing prescriptions on other than government forms. "What virtue is there in a government prescription form? Does it make the drugs any more potent? The National Health Service Act provides that the Government may make regulations prescribing all matters which are by the act required or permitted to be prescribed or which are necessary or convenient to be prescribed, for carrying out or giving effect to the act. Surely that is a suffi- ciently wide charter. What reason is there, then, for this bill? Has it been introduced so that the Government can put into operation its national medical scheme without again approaching the Parliament? Is it an attempt to make valid certain legislation already enacted so that it can sustain a challenge in the High Court? Is it one more attempt to rivet the chains of nationalization of the doctors? If so, I am convinced that it will fail of its purpose.

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