Title Community Affairs Legislation Committee
19/10/2011
Estimates
HEALTH AND AGEING PORTFOLIO
National E-Health Transition Authority
Database Estimates Committees
Date 19-10-2011
Committee Name Community Affairs Legislation Committee
Page 178
Questioner McKenzie, Sen Bridget
Fierravanti-Wells, Sen Concetta
Siewert, Sen Rachel
Responder Ms Halton
Mr Fleming
Mr Bartlett
Ms C Wilson
Ms McDonald
Ms Ward
Ms Bryant
System Id committees/estimate/f3aa23a6-536a-473f-a69d-7fe59ae35651/0010


Community Affairs Legislation Committee - 19/10/2011 - Estimates - HEALTH AND AGEING PORTFOLIO - National E-Health Transition Authority

National E-Health Transition Authority

[22:17]

CHAIR: Senator McKenzie, NEHTA are here. Can you do your questions in 10 minutes?

Senator McKENZIE: Thanks to Senator Boyce, we have oodles and oodles of questions for NEHTA.

CHAIR: The 'oodles' will be 10 minutes and the rest will be on notice.

Senator McKENZIE: Yes, absolutely, Chair. Mr Fleming, are you aware of the steady stream of criticism directed NEHTA and its parent DOHA by local industry of their handling of IT and software tendering and contracting?

Ms Halton : And I am pleased to know that I am his parent!

Senator McKENZIE: You are looking remarkably well!

Mr Fleming : The structure of NEHTA is that we are owned by the Council of Australian Governments, so all of the governments obviously contribute as per the COAG formula. Therefore, the Commonwealth contributes 50 per cent plus obviously also the PCEHR relationship. As part of that, Ms Halton sits on the NEHTA board.

In terms of the stream of criticism, there have been, obviously, a number of comments in terms of various aspects of the tendering process. As Mr Madden mentioned earlier on, for the tenders around the PCEHR, all have followed Commonwealth guidelines and all have had independent probity assessments as part of that process. So we have all the way through followed Commonwealth guidelines in that process.

Senator McKENZIE: Given there has been some issues around that—Oh, now I am asking you for opinion. Okay.

Mr Fleming : Sorry.

Senator McKENZIE: I have had another question tonight in the Defence portfolio, where there were issues. Yes, it is Senator McKenzie's first estimates! So you have outlined those issues in that regard—it is around the tendering.

Mr Fleming : The tendering process has absolutely followed Commonwealth guidelines all the way through and, as you are aware, there have been many tenders issued through that process.

Senator McKENZIE: Thank you.

Senator McKENZIE: The proposal by NEHTA to have 'tiger teams' develop key standards in less than one month and bypass the normal Standards Australia process could have enormous and negative consequences. Please respond.

Mr Fleming : The tiger teams is a process we have used for a number of years now, and certainly was part of the process for the individual health identifiers. This is not a process that has been underway for one month. In terms of specifications that have been developed, it has been happening for a long period of time and, as Mr Madden mentioned earlier on, it is absolutely not bypassing the Standards Australia process. The tiger teams consist of representatives from key stakeholder groups, including clinicians, technicians, vendor reps et cetera. Through that group we put together a series of specifications which are then, through the wave 1 and 2 sites, tested in the field and then followed through with the Standards Australia process thereafter. It is very much in line with what Mr Madden mentioned earlier on.

Senator McKENZIE: Thank you. I have some further questions from Senator Boyce. This goes to the work culture and staff morale at NEHTA. How would you describe that, Mr Fleming?

Mr Fleming : We are, as you would expect, as are all groups associated with this program, working long and hard. We have some of the most talented and intelligent people in the country working on this program. There is an absolute commitment towards delivering this for the benefit of all Australians.

Senator McKENZIE: The capacity of your staff is not the question. How are they feeling?

Mr Fleming : How are they feeling? It is hard to give an opinion on that. We have been doing some research in the area of morale. We have an external company looking at that. I have not got the final research back. However, the verbal update I have received is that morale is actually quite high in the context of everything we are working on.

Ms Halton : Senator McKenzie, I can tell you that from a board perspective—if I can put that hat on for a second—we have a conversation with management quite regularly about what is going on, reasons for exit et cetera. So in terms of board duties this is a matter which is discussed.

Senator McKENZIE: Thank you. Has the NEHTA headquarters in Sydney been subject to a New South Wales WorkCover investigation following bullying complaints?

Mr Fleming : There was just recently a very brief investigation. I believe a WorkCover officer came and had a talk to our head of personnel and I believe that that issue was dealt with to their satisfaction immediately.

Senator McKENZIE: Thank you. Could you please provide details of NEHTA's staff turnover over the past 12 months?

Mr Fleming : The annualised turnover is approximately 28 to 30 per cent over that period of time.

Senator McKENZIE: Is that high?

Mr Fleming : It is reasonably high, yes. The research we do is in relation to the type of organisation—a transitional authority—and how it compares to other consulting groups. In terms of consulting groups, it is actually on par with what we see in the industry. In terms of what we would expect if we compare with the IT industry, it is probably significantly higher than we would want to see. So we have commissioned research to talk to our staff and understand the drivers behind that and what we need to do.

Senator McKENZIE: That does me for NEHTA. There will be questions on notice.

CHAIR: There will be many questions on notice, Mr Fleming. That concludes outcome 10. Thank you to the officers.

[22: 24]

CHAIR: We will now move to outcome 9, Private health.

Senator FIERRAVANTI-WELLS: Did you see the article in the Sydney Morning Herald on 14 October entitled 'Roxon hits monster health bill'? Mr Bartlett, yes, I see you have dreamt about it too.

Ms Halton : We never dream about Mark Metherall.

Senator SIEWERT: Nightmares!

Ms Halton : Yes, Mark Metherall, definitely. Hello, Mark!

Mr Bartlett : Yes, I am aware of it.

Senator FIERRAVANTI-WELLS: Have there been any revisions to the government's projection of the impact of the proposed rebate changes?

Mr Bartlett : There has been a minor revision that took the estimated impact on hospital policyholders reduction from 25,000 to 27,000.

Senator FIERRAVANTI-WELLS: Sorry?

Mr Bartlett : Twenty-five thousand was the estimate that was done when rebate means-testing was first proposed. It was reviewed recently and it is now 27,000.

Senator FIERRAVANTI-WELLS: How many Australians in 2010-11 had to pay the Medicare levy surcharge?

Mr Bartlett : We do not have that information available. I think it is actually Treasury information. I can take it on notice and check whether we can get it for you.

Senator FIERRAVANTI-WELLS: Will you take it on notice and if you cannot supply it will you forward that on to Treasury?

Ms Halton : Yes, I suspect that is where it will end up.

Senator FIERRAVANTI-WELLS: How many people who earn under the threshold for the Medicare levy surcharge have private health insurance? Do you have that statistic?

Mr Bartlett : I suspect it is a statistic that we have because a fair amount of work has been done in preparing for this. I do not have it with me; I will have to take notice.

Senator FIERRAVANTI-WELLS: Okay. What is the latest update on the number of people with private health insurance who fall within the thresholds affected by the rebate change—of the revised figure of 27,000?

Mr Bartlett : The 27,000 is the number anticipated to drop their private health insurance. They are certainly within the thresholds. There is a much larger group within the thresholds who are anticipated to continue to hold their private health insurance.

Senator FIERRAVANTI-WELLS: Do you have the figures for the number of people with private health insurance who fall within the thresholds affected by the rebate changes? Do you want to take that on notice as well?

Mr Bartlett : I have some overall figures; I do not have a breakdown by category. I will have to take that on notice.

Senator FIERRAVANTI-WELLS: Thank you. Has any research or modelling been done on the impact of the private health insurance rebate changes without the proposed increases in the Medicare levy surcharge? If so, what did that find?

Mr Bartlett : No, there has not. It has been modelled as an overall proposal—

Senator FIERRAVANTI-WELLS: As an overall proposal with all the components?

Mr Bartlett : That is right.

Senator FIERRAVANTI-WELLS: What was the value of benefits paid by private health insurers for hospital services in Australia in 2010-11? If you do not have that with you, could you take that on notice?

Mr Bartlett : I have that here. In terms of hospital episodes, there were 3,380,689 and of those insurers paid out $2.5 billion in total hospital benefits in the June 2011 quarter. The annual figure is $9.7 billion.

Senator FIERRAVANTI-WELLS: Thank you. What was the average cost of single and family hospital cover policies for 2010-11?

Mr Bartlett : We will have to take that on notice.

CHAIR: Thank you to the officers from outcome 9.

[22:31]

CHAIR: We will now move to Hearing Services under outcome 7, who are not last this evening, but very close.

Senator SIEWERT: I am after an update on the implementation of the recommendations from the Senate inquiry report that were funded under the budget initiatives.

Ms C Wilson : Would you like me to take you through each of the components one by one?

Senator SIEWERT: Yes.

Ms C Wilson : We are on track for implementation according to time frames. We will be issuing three-year vouchers from 1 January 2012. We are working closely with stakeholders on the development of the arrangements. We have held national face-to-face consultations on the voucher changes between June and August. To facilitate input from people who were unable to attend the face-to-face meetings we have posted all of the relevant documentation used at the consultations online and invited input from stakeholders. That is due on 2 November.

Senator SIEWERT: That is the finalisation of that consultation process.

Ms C Wilson : When we get that input in we will revise the relevant documentation, repost it and allow people a consultation period to look at it so that they can see all of the documentation as a whole and how it interacts and then we will move towards finalising that. So the documentation around the contract and the rules of conduct et cetera do not need to be in place by 1 January.

Senator SIEWERT: Is it okay with you if I cross-reference back to some of the recommendations from the committee report?

Ms C Wilson : Yes.

Senator SIEWERT: Part of that process you have just been talking about is just to do with the voucher program itself. Recommendation 11 had other parts and as part of the government's response they said that they accepted in principle and that you would be carrying out discussions with stakeholders. I am wondering whether as part of your process you are looking at those other issues or whether that will be done later on. Am I making sense, you look a bit nonplussed?

Ms McDonald : There are a number of areas where we are implementing things. For the voucher program there are two lots of changes to the CSO, the extension to 26-year-olds and the increase for population growth and also the improved IT. In relation to a number of the other recommendations there is a series of actions happening. I am just wondering about the best way to go through those. There are 34 recommendations, and there are a number of things we have done. In some cases we are picking up comments as part of consultations that are already underway. We are allowing stakeholders to comment on issues that are broader than just the things being implemented, and we are collecting that information. In other cases a number of the recommendations related to the work of state and territory governments.

Senator SIEWERT: Exactly, and I wanted to deal with those as well.

Ms McDonald : We certainly have started the process of discussions with other portfolio ministers. Minister Butler has written to a number of other ministers, alerting them to the recommendations. We have had the Hearing Services Consultative Committee also talk about some of these issues. They are looking at some work they might do over the next period to investigate some of the areas that did require further work.

Senator SIEWERT: It looks like you have a table there—and we just love tables! Is it possible to get that? I think it will save us all a lot of time. I thank you for your answer. It is obvious you are going through the recommendations, taking them pretty seriously and implementing them—even the ones the statement says are a state and territory responsibility.

Ms McDonald : How about we provide you with a table with an update? There are some bits for which we are still waiting on input from other portfolios, so we could get you on notice a table with an update of where things are up to from our perspective.

Senator SIEWERT: That would be fantastic. You are probably aware that I am going to be chasing these and going through the recommendations. We can then just go to the ones for which we need some more updates. That would be really appreciated. Thank you. I think that would probably save me going through these recommendations that I have written down and that I particularly want to follow up. I do want to keep going, though, on the voucher issue and the process that goes on the website on 2 November—is that correct?

Ms C Wilson : It went up on the website on 13 October, and people have until 2 November to put in comments.

Senator SIEWERT: And where do we go from there?

Ms C Wilson : Then the department will be looking at all the input we have received through the consultation process, taking that into account, making revisions to the document and seeking further advice where we need to. Once we have that set of documents we will put them on the website as well and alert service providers and practitioners that they are up there. We will give them a good period of time to look at those, provide further input and raise any concerns or issues. Then we would finalise them and send the contracts out for signature et cetera.

Senator SIEWERT: What is the time line for that?

Ms C Wilson : Their current contracts expire on 30 June 2012, so we have that sort of period in which to do it and allow adequate consultation.

Senator SIEWERT: And I suppose there would be an expectation that there would be a period of time before 30 June so that you can get the contracts done. Is that right?

Ms C Wilson : Yes, they would be done well before 30 June.

Senator SIEWERT: Since Senator Fierravanti-Wells has some questions as well, I will keep going for just another minute or two, if that is okay. I know I will have to go next door to ask about funding for disabilities in schools, but perhaps I can ask you whether you have any interaction with DEEWR over that.

Ms Ward : We have had conversations with DEEWR. We keep in touch with our contacts in DEEWR. We understand that they are developing the menu of items that educational authorities can make submissions for, depending on what their local needs are, and that they are doing some consultations with stakeholders as well. We have directed some of our stakeholders to those consultations.

Senator SIEWERT: We discussed last time that you thought that would include the ability to apply for funding for SoundFields. Have you raised that issue in your discussions?

Ms Ward : We have, and it remains my understanding that that will include SoundFields.

Senator SIEWERT: My final question before I hand over is about extending from 21 to 26. How is the process for that going?

Ms C Wilson : Australian Hearing is the only provider of community service obligations, so we are working closely with them around revising our funding agreement et cetera and also talking to them about the communication strategies and how we ensure that this group of people know they are going to become eligible for services. Most of them will have been Australian Hearing clients as children—

Senator SIEWERT: That is what I presumed.

Ms C Wilson : and so they will be doing a direct mail-out to people, letting them know and inviting them to make an appointment. We are also looking at some arrangements for that small number who may not fall into that category or who have moved. We have talked to the Australian Society of Head and Neck Surgeons about getting some information out through them to ear, nose and throat specialists and we are also looking at options to getting information out to general practitioners, perhaps through the divisions network.

Senator McKENZIE: Thank you for attending at this late hour. On page 220 of DoHA's annual report, one of your deliverables not met is around a number of clients accessing rehabilitation services. You instituted a review in May this year for policy consideration in early 2011. We are nearing the end of October so I am assuming you would want to meet those timelines and still have a swim at the beach over summer. There might be some preliminary findings from that review. Could you talk us through what they might be?

Ms Ward : The consultants that provided the review provided it at the end of June. We are in the process of working our way through the recommendations from those consultants and considering the options for taking some of those recommendations forward. While we were doing the consultations for the budget 2011 policy implementation we took the opportunity to raise that with practitioners and there was a lot of interest in rehabilitation. We undertook that once we developed some potential options for going forward we would do a web based consultation with them on that matter, to get their feedback and ideas so that we could feed that into advice for government and consideration of ways forward on the review.

Senator McKENZIE: The number of regional Australians accessing your services and the number of sites registered to provide services under the hearing service program: how many of those are located outside of capital cities. The number of people receiving hearing services: the number of those that are located outside of capital cities. You may want to take these on notice.

Ms Ward : We will take those on notice.

Senator FIERRAVANTI-WELLS: In relation to page 219 of the annual report, when does the funding agreement with Australian Hearing come up?

Ms C Wilson : The current MOU with Australian Hearing for the CSO arrangements expires on 30 June 2012.

Senator FIERRAVANTI-WELLS: Of the number of sites registered to provide services under the hearing services program the target is 2,001—and it is 2,230. Are they all Australian Hearing sites or do they include some private providers?

Ms Ward : No, they would be private providers and Australian Hearing.

Senator FIERRAVANTI-WELLS: What is the breakdown of those 2,230 between private and Australian Hearing?

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

Senator FIERRAVANTI-WELLS: Of the people receiving hearing services, could you also tell me of that number—599,581—how many received services at Australian Hearing or at a private provider?

Ms Ward : We will take that on notice as well.

Senator FIERRAVANTI-WELLS: Could you tell me the number of providers?

Ms Ward : The number of providers is 220.

Senator FIERRAVANTI-WELLS: In terms of the percentage of the work, can you take on notice how much of the work is actually being done by private providers and how much of it is being done by Australian Hearing?

Ms Ward : Yes.

Senator FIERRAVANTI-WELLS: Are those private providers located around Australia?

Ms Ward : They are.

Senator FIERRAVANTI-WELLS: And on the Australian Hearing website there are all the locations of the offices. How many staff has a typical office of Australian Hearing?

Ms Ward : I do not know that.

Senator FIERRAVANTI-WELLS: Your total budget for 2011-12 is—

Ms Ward : The projected budget for 2011-12 is $410.66 million.

Senator FIERRAVANTI-WELLS: How much of that is paid over to Australian Hearing? Could you take that on notice?

Ms Ward : Yes, we could probably more easily do that for 2010-11, because it is driven by client numbers.

Senator FIERRAVANTI-WELLS: Of course. You probably have statistics in relation to 2009-10 and 2010-11, just to give a comparison. In the portfolio budget statement at page 239 it says, 'Support Access to Quality Hearing Services' and it sets out the quantity of deliverables for the program. Could you give me, roughly, a breakdown of those figures to be provided by Australian Hearing as opposed to private providers, thank you. Then on page 220, I notice the perennial problem of the percentage of fitted clients who use their devices for five or more hours a day. Is that increasing slowly or is it still the perennial problem? It is generally my father's description—

Ms Halton : We have had this conversation before.

Ms Ward : It is increasing.

Senator FIERRAVANTI-WELLS: I am very happy to hear that, Ms Ward. It has not increased in my household!

Ms Halton : Well, n=1 is not a good sample, Senator.

Senator FIERRAVANTI-WELLS: I try. It is not for the want of trying. Seriously, obviously it is increasing. If my memory serves me correctly, Ms McDonald, it is one the recommendations of the report. It looked at ways of increasing that—

Ms McDonald : That is correct, Senator. Over the next year or so we will be doing a bit of work to have a look at what can be done there.

Senator FIERRAVANTI-WELLS: If my recollection serves me correctly, there was also some research money going over to NHMRC to do some research on hearing. I think it was particularly targeted at young people.

Ms Ward : Young people, Indigenous people, and those in the workforce.

Senator FIERRAVANTI-WELLS: Okay. In answer to the question from Senator Siewert, I am most interested to hear about promotion of hearing services particularly amongst our young people. They seem to keep these things in their ears all the time. It must not be doing anything positive for them— and I think that we have had this conversation before. I am interested to know from your perspective: does the material that you are putting out include areas where young people gather, and those sorts of things? Just take that on notice, Ms Ward.

Ms Ward : Yes.

CHAIR: Thank you very much, officers from Hearing Services. We will now move to outcome 14 and the patient officers from Biosecurity and Emergency Response.

[22:49]

Senator FIERRAVANTI-WELLS: Are there any particular threats that have been targeted as part of the health emergency planning and the national stockpile?

Ms Bryant : Broadly, the stockpile exists to provide measures that may be needed in a health emergency, not only in respect of a pandemic but also across all categories of chemical, radiological, nuclear and biological events.

Senator FIERRAVANTI-WELLS: Earlier we talked about the CSL and the FDA warning letter. Can you tell me what CSL products are currently in the national stockpile, how many units there are, what their value is and when they were purchased?

Ms Bryant : We will take that on notice.

Senator FIERRAVANTI-WELLS: Thank you. I did ask earlier about whether there are any other products in the national medical stockpile or on the National Immunisation Program that are subject to any investigation, whether by the TGA, FDA or another regulator. I do not know if that overlaps, but if you could—

Ms Bryant : Was that a question only about the CSL products under investigation or any products?

Senator FIERRAVANTI-WELLS: No, it was about whether there are any other products in the national medical stockpile or on the National Immunisation Program that were the subject of any investigation by the TGA, FDA or any other regulator, and, if so, what the details are.

CHAIR: Thank you to the officers from outcome 14 for your patience. There have been significant questions put to all the programs, and we do appreciate your cooperation, Ms Halton, and that of your officers. That concludes today's hearing.

Committee adjourned at 22 : 57