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Wednesday, 13 October 1971
Page: 2262

Mr IRWIN (Mitchell) - I shall commence my remarks by commenting on the speech made by the honourable member for Oxley (Mr Hayden). In his opening remarks the honourable member for Oxley was not very complimentary to the honourable member for McMillan (Mr Buchanan). 1 have served on 2 statutory committees with the honourable member for McMillan. On both committees he took up the position of chairman after they had been going quite a long time. I should say that there would be few honourable members in this House who could pick up the threads and get a full understanding of a situation as can the honourable member for McMillan, especially as he did in relation to the House of Representatives Select Committee on Aircraft Noise and the House of Representatives Select Committee on Pharmaceutical Benefits. There are few people in this House or anywhere else who could have picked up the threads and controlled those committees in the way in which he did.

Although the honourable member for Oxley moved an amendment to the motion for the second reading of the speech he did not speak to any of the proposals contained in his amendment. I notice that the amendment does not in actual fact oppose the second reading of the Bill. Because it has not the courage to bring in something definite itself the Opposition has moved an amendment which contains proposals that are so unimportant and impotent that I will not even bother to read them out. The honourable member for Prospect (Dr Klugman) made some sneering remarks about the present Minister for Health, Senator Sir Kenneth Anderson. I want to inform the honourable member for Prospect that Senator Sir Kenneth Anderson is one of the most notable hospital administrators in the whole of Australia. He was for many years the Chairman of the Ryde District Hospital, which is renowned as one of the most efficient hospitals in Australia. So to say that the Minister for Health does not know anything about the health problems that exist in Australia is ludicrous in the extreme. Anyone who knows Senator Sir Kenneth Anderson knows of his humanity, his sympathy and his desire to assist his fellow man. He is renowned throughout New South Wales for these qualities. I am sorry that I was not able to follow the remarks of the honourable member for Prospect. 1 do not know whether the microphone in front of him was out of compass or just what it was, but it was very difficult to understand what he was saying. I have checked with other honourable members in this section of the chamber about this matter and found that they had the same difficulty. But I shall not dwell on that aspect as I have other things to say.

Following the announcement by the Prime Minister (Mr McMahon) of the intention of the Government to increase the daily benefits paid on behalf of nursing home patients by $1.50 a day to $3.50 tor ordinary patients and $6.50 for intensive care patients there has been criticism of the standards of care in some nursing homes. The Leader of the Opposition (Mr Whitlam) has been particularly critical of the standards of nursing homes and has also claimed that the Government, in announcing its intention to provide higher patient benefits, has been concerned with the welfare not of patients but of nursing home proprietors. As usual in situations of this kind the criticism exaggerates areas of deficiencies and ignores the tremendous value of the nursing home benefits provided by the Commonwealth to the sick and aged people in the community. The statements by the Leader of the Opposition highlighted deficiencies acknowledged to exist in a minority of private nursing homes and implied that these conditions apply generally. In suggesting that the increased patient benefits will assist nursing home proprietors more than patients the Leader of the Opposition completely ignored the fact that it is in the interests of patients that both public and private nursing homes should be enabled to remain solvent.

The question of the establishment and maintenance of standards for nursing homes is, of course, most important. The Commonwealth is concerned to see that the patients it is assisting receive the highest possible standards of care, but it should be realised that the application of standards is primarily a responsibility of the State governments. It is the State governments which have the legislative responsibility for registering nursing homes and it is also mainly their responsibility to supervise the standards of these homes. To discharge these responsibilities each State has its own inspection teams which carry out inspections directed to the standards of nursing homes. It follows that any criticism of standards of a particular home should be directed, in the first instance, to the State authorities. The Commonwealth Department of Health, which administers the nursing home benefit scheme, also maintains a degree of supervision of nursing homes but this is concerned largely with the payment of patient benefits. Close co-ordination is, of course, maintained between the Commonwealth and State authorities and, where unsatisfactory features are disclosed by Commonwealth inspections, requests are made for remedial action and the State authorities are advised. There is, it is acknowledged, a need for even greater co-ordination in this area. The Minister plans to have consulta tions with the responsible State Ministers regarding an intensification of efforts by the State authorities to ensure that all nursing homes provide the same high level of care as is in fact provided by the majority.

The claim by the Leader of the Opposition that the increased patient benefits will assist proprietors rather than patients is a gross over-simplification of the position. To have a full appreciation of the nursing home situation in Australia it is important to realise that nursing homes fail into 3 main groups. There are nursing homes operated by religious and charitable organisations which provide very satisfactory standards of care and usually charge only what the patients can afford to pay. Lately these homes have had great diffculty in meeting their costs. The Government expects that these homes will generally absorb the increased nursing home benefits into increased patient fees but that these fees will still be no higher than the patients can afford to pay. The patients will benefit in that the increased payments will help to save homes from becoming insolvent and having to close. The second group of homes are those run by the various State governments. From the Commonwealth's viewpoint the main deficiency of these homes is that they are too few in number and that patients cannot always gain quick admission. In order to bolster the growth of State operated nursing homes the Commonwealth has offered the States capital grants on a dollar for dollar basis. The third category of nursing homes is comprised of those run by private proprietors. It is unfortunate that of these homes do not always provide adequate care for their patients. It is these homes that require the greatest supervision by the State governments.

Nobody should belittle the part that private homes are playing in the nursing home scheme. Without such homes, great numbers of sick elderly people would be unable to receive the kind of care and accommodation they need. As regards the fees in private homes, it is a fact that the majority generally charge fees which are greater than the total of Commonwealth nursing home benefits and other social service payments available to the patients. In this situation I trust that the increased nursing home benefits will largely be directed to reducing the gap that the patients would otherwise have to meet from their personal resources. In this respect it is worth noting that the Secretary of the Private Hospitals and Nursing Homes Association of Victoria, Mr P, Giles, has refuted reports inferring that nursing homes will raise their fees because of the increased Common' wealth benefits and has stated:

Our members are fully aware the increases are a patient subsidy and not a hospital subsidy and have been introduced to alleviate hardship among those who most deserve and need it.

On the subject of nursing home charges in general, it is a fact that nursing homes in some States have already justifiably raised their charges to take account of recent rises in nursing salaries. When, inevitably, nursing salaries are increased in other States, some fee increases in nursing homes will be unavoidable in many cases. It is the increasing cost of providing nursing home services that is the basic cause of higher nursing home fees and it was in recognition of this fact that the Commonwealth has intervened and proposes, subject to the passage of the necessary legislation, to increase by $1.50 a day the benefits it provides. That is the Government's outlook in regard to this matter. Paradoxically, we would have an over supply of beds for the aged and the infirm if we were to allocate the beds taking into account the position of the patients. A great percentage of the patients in aged people's homes could be accommodated in a hostel type of home or, much more preferably, within the homes of their relatives.

We have been told that in one State hospital in New South Wales of the 266 patients 133 - exactly 50 per cent - were rehabilitated and allowed to go home. Other patients who are immobile and restricted, if they had their own homes or small flats built near shopping centres, would require attention and assistance from someone outside to come in only one half day a week. In some cases that assistance would be required on two half days a week. So there appears to be a loss and wastage by not being able to co-ordinate the aged and place them in homes, hostels or private homes depending on their category. Of course, there has been a great increase in the number of aged people requiring this attention.

I think that it should be known throughout Australia that we lead the world in regard to the care of the aged. America has spent millions of dollars on this assistance but it is still not comparable to what we are doing. Although we lead the world in this regard we should never become complacent. We should go flat out to meet further the situation for these people who have done so much for Australia.

One thing I wanted to speak about was cosmetic surgery but it does not take a big pari in this scheme. It was not thought of when the legislation was first framed but some provision should be made whereby a person who undergoes a cosmetic operation which is not necessary should pay a greater portion of the fee. One honourable member opposite spoke about medical fees, common fees and specialists' fees. It is to the everlasting credit of a great number of specialists that when treating people in the middle to high income bracket, the specialists, knowing that these people have families to rear and are paying off their homes, have been satisfied to take the contribution from the medical benefits funds. I know of hundreds of such cases.

The estimated cost of pharmaceutical benefits for 1971-72 is $160m. After hearing what the honourable member for Prospect had to say, I think that the medical profession should be more careful and should realise the great cost to Australia of pharmaceutical benefits. Although the prescription they write out may come to only 40c, if that medicine was not necessary it should not have been prescribed. 1 appeal to the medical profession to realise the great cost of pharmaceutical benefits and to endeavour, without stinting or in any way endangering the lives of their patients, not to prescribe something just for prescription's sake.

I want to refer now to the very serious matter of the admission to hospital of baby Rowcliff who was just a few days old. The baby was admitted to hospital with its mother on the direction of a medical practitioner. I do not know how else one can get into a hospital unless one is admitted on the recommendation of a medical practitioner. This baby, only 8 days old, was in hospital for 8 days. The hospital fee was $112. Mr Rowcliff is in very humble circumstances. The Medical Benefits Fund of Australia refused to pay the SI 12. The medical superintendent stated that the baby was not covered under the Act. Unfortunately, 2 Ministers of Health have ruled that the Medical Benefits Fund of Australia was right in its refusal. It grieves me to think that such a mean and contemptible attitude should be adopted in the case of this child who was only a few days old and who had to return to hospital with its mother. I understand that the child had gastric trouble and was admitted on the basis of the letter and on the advice of the family's medical practitioner. I do hope that the Minister at the table will take note of what I have said. Even if the Act or the regulations have to be amended surely we can extend humanity to these people so that they will not have to pay this SI 12 from their very meagre income.

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