Thursday, 10 February 2011
Questions without Notice: Take Note of Answers
That the Senate take note of the answer given by the Minister for Agriculture, Fisheries and Forestry (Senator Ludwig) to a question without notice asked by Senator Fierravanti-Wells today, relating to health.
I rise to take note of answers given by Senator Ludwig in relation to what has now become the debacle of health reform in this country. Labor’s so-called hospital grand plan is collapsing around this government’s ears. Despite all the huffing and puffing by Julia Gillard and Labor we are seeing these changes for what they originally were—that is, heading back to business as usual in our hospital systems. Of course if New South Wales is anything to go by, they will be the decrepit hospital systems that have been the legacy of 16 years of Labor in New South Wales.
My question to Senator Ludwig was directed at the assertion—and it has been only an assertion; the whole thing has been just smoke and mirrors—of federal funding and local control. Let me just examine that. Federal funding, of course, disappeared the moment the cameras were no longer on it. We had the much-trumpeted national funding authority. The national funding authority was to be the mechanism in these changes that would deliver much-needed transparency. In fact, if you go back to the red book, which seems a distant memory, there you have it. It outlines the necessity for transparency and accountability. They were so concerned with ensuring that ‘scarce health dollars’ be directed to hospital services because they did not trust the states. So what happened? All of a sudden the national pricing authority disappeared. Interestingly enough, the decision was made through the Department of the Prime Minister and Cabinet. Minister Roxon was left looking like a stunned mullet because she did not really know about it. The decision had been made by Dr Rudd’s department.
Then we had the other debacle, the other lie about this so-called reform: the perpetrated misconception about local control. You only have to look at the nitty-gritty of the agreement—which of course is not an agreement in the true sense of the word because it has no legal binding between the Commonwealth and the states—on page 14 and there it is in black and white: the clinical expertise on the local hospital networks will come from outside the local hospital networks. What is the point of having a local hospital network when the clinical expertise, the starting point, comes from outside the hospital network?
Senator Corman, I will tell you why—because the appointments to the local hospital networks will come from the state bureaucracies. Dr Rudd, ably assisted by Ms Roxon as the nurses aid, in the photographs—and of course we do have plenty of those photographs floating around—is really what it was all about. It was about Kevin Rudd traipsing around the countryside in a doctor’s uniform, scrubbing up, with Ms Roxon next to him always dressed up as the nurses aid. It was about the photo shoots; it was about trying to create the perception that we are doing something about reform. But really it was all about spin and no substance. It is little wonder that the whole thing is falling apart.
It was not ever a national agreement because of course Western Australia was not part of it.
Absolutely. And of course Victoria were not fully part of it because they were not part of HACC. So this whole misconception about federal funding and local control is the spin that it always was.
I rise to take note of the answer referred to by Senator Fierravanti-Wells and I wish to discuss the issue of health reform. Senator Fierravanti-Wells has tackled this question with customary passion but her sneering contempt for the Minister for Health and Ageing did her no credit. Likening her, in such a sneering way, to a nurses aid is an inappropriate way to recognise the hard work and efforts of nursing aids and nursing staff across the country.
Health reform is a critical issue for Labor. It has been a critical issue for Labor for many years. Health is one of the quintessential policy areas which Labor have long regarded as a priority. Labor have long insisted that health reform be a continuous program of government. Those opposite have long had a policy which, at its root, has had a distrust and indeed hatred of Medicare and a philosophical opposition to the notion that universal health coverage and universal health care was an appropriate way to manage health costs in this country. We come at this from positions which are poles apart.
In more recent times, under Prime Minister John Howard, those opposite made the practical decision to support Medicare, at least in their public utterances, because Medicare and its predecessor Medibank had not only been successful Labor innovations but also had become part of the bedrock of this country. It was no longer sustainable for those opposite to oppose such an important reform.
In recent years we have seen Labor continue its very proud record of supporting and strengthening Medicare and health care in this country. That was a key issue for Prime Minister Rudd last year and it remains a key issue for the federal Labor government today. Those opposite may sneer. They may try to belittle the achievement so far, but let us consider for a moment what some of the real gains have been. Keeping people healthier and out of hospital by providing health services closer to home is simply common sense. That is why under Labor 64 GPs superclinics have been promised—
Those opposite might contain their enthusiasm for a moment in the faint hope—dare I say ‘risk’—that they may learn something. GP practice upgrades have meant 4,600 practice nurses and 28 of the original 36 GPs superclinics are now either completed, operating interim services or under construction. These are real and tangible gains. If those opposite had struggled through the trauma of watching them being built and dealt with their own policy failures, they would have seen that for some communities they represent real achievements and real improvements. We lifted the cap on Mr Abbott’s GP training quota and that will mean that by 2014 we will have doubled the number of GPs entering training—that is to say that the pipeline of trained GPs has been opened again by federal Labor after it was strangled not only by a coalition government but by Abbott, who was then minister for health.
I am delighted to do that but, Mr Deputy President, although I cannot help but note that you did not enforce that with such rigidity when Minister Roxon was being referred to as a nurses aid.
I will refer to the Leader of the Opposition in the appropriate terms, Mr Deputy President. Securing the health workforce of the future by training 1,000 extra nurses a year and over 6,000 more doctors over the next decade is a real and tangible achievement. In e-health, personal electronic health records for every Australian will realise real gains. It will minimise medication errors and make the delivery of health services simpler and more efficient. E-health will connect Australians to specialists and after-hours GPs with telehealth and broadband. But I forget that broadband itself is loathed by those opposite. Perhaps under your amendments a carrier pigeon could fill that role! Around prevention, we have implemented the world’s strongest anti-smoking campaign—one which, tragically, has had no effect on me—including the world’s first plain packaging; combating obesity (perhaps another personal weakness); alcohol abuse (there I am on safe ground)— (Time expired)
This Labor government has been an absolute failure in health. Before the 2007 election they promised the world but they have delivered next to nothing. Kevin Rudd, the then Leader of the Opposition, said he had the plan.
Mr Kevin Rudd, the then Leader of the Opposition, said before the 2007 election that he had a plan to fix public hospitals. After the election—no plan. Instead what we got was an 18-month review through the National Health and Hospitals Reform Commission to try to come up with a plan to fix public hospitals, as Kevin Rudd, then Prime Minister of Australia, would say. Did they implement that plan? No. They had a review into the review but the plan by the National Health and Hospitals Reform Commission is gathering dust to this day. When all of the options had run out and finally they were approaching the next election, when clearly they had not delivered and we had all talk and no action, what happened? They thought, ‘We’ll pick a fight with the states. We’re going to go for a crash grab at the expense of the states,’. They were casting around for some more cash. ‘We’ll try to get one-third of the GST revenue from the states and territories. We’re going to take $200 billion away from the states over the next 10 years to 2020.’ What did they give the states and territories in exchange? Between now and 2020, $15.6 billion. That is the deal that Prime Minister Rudd, Treasurer Wayne Swan and health minister Nicola Roxon tried to implement in the lead-up to the last election and that is the deal that Julia Gillard, our Prime Minister, is now walking away from.
The states clearly have realised that this is a bad deal for the states and a bad deal for patients. That is why they are all walking away from it. That is why not a single state Labor government has signed onto it. That is why not a single state Labor government, 10 months after the April 2010 COAG meeting, has signed on the dotted line to hand over their share of the GST to the federal government. The Prime Minister will now try and blame it on the coalition governments in Victoria and Western Australia. Nothing could be further from the truth. It is very important for people to understand that not one single state or territory Labor government has signed up to this deal.
Of course the government are all over the place. Last night government senators from the economics committee tabled a report in this chamber recommending that the Senate pass legislation to take away a third of the GST from the states and territories, while the Prime Minister is out there saying, ‘The deal is dead. We’re not going to proceed with taking the GST away from the states and territories.’ Of course the reason the deal is dead is that, when people like Premier Bligh in Queensland and Chief Minister Jon Stanhope in the ACT looked at what they were asked to hand over to the Commonwealth, they realised that it was a bad deal for their respective states. Queensland is to hand over 40 to 44 per cent of their GST revenue to the Commonwealth, the ACT 50 to 51 per cent of their GST revenue to the Commonwealth and Western Australia—of course, if Western Australia had agreed to be part of it—60 to 63 per cent of their GST revenue to supposedly fund this deal.
How is shifting money from the states and territories to the Commonwealth ‘health reform’? How is shifting money from here to there actually going to make any tangible, beneficial outcome for patients? Of course it does not. I believe that, when state Labor premiers and chief ministers decided to agree in principle—probably precipitously at the April 2010 COAG meeting—they did not have the specific estimates in front of them as to how this particular deal was actually going to impact on their state budgets. The reason not one of them has signed up to this day and the reason they are now all seeking cover behind Premier Barnett and Premier Baillieu—and are quite happy for them to take the blame for the deal falling apart—is they are quite comfortable with it not going ahead. Of course I bet that the Prime Minister has been told privately that state Labor leaders are no longer comfortable to go ahead with this either.
This government has been a failure in health. They came up with a smoke-and-mirrors cash grab which was never health reform. It was always just about centralising revenue in Canberra at the expense of the states without actually making any of the hard decisions.
I am always amazed when those on the other side bring up issues such as this when they have actually cut money out of the budget. We all know that they ripped $1 billion out of the health system. To me that is pretty uncaring, unkind and callous to the people of Australia. Of course that left a great big hole—didn’t it?—that is now down to Labor to fill.
Health is a critical issue to the Labor Party. We have long been working on a better deal for patients. That is our bottom line. We want a better deal for patients. Why do we want that? We want that because we care, because we have compassion and because, as I said, we want a better deal for patients all around. In fact a better deal for patients all around means a better deal for the whole of society. As I said, those on the other side cut $1 billion out of the health budget and I am always astounded that they actually have the gall to raise the issue.
This Labor government is delivering massive reforms. We have delivered the MyHospital website, we have increased hospital funding by 50 per cent and we have delivered 70,000 more elective surgery operations. On top of that we have agreed to new boundaries for local hospital networks. I heard Senator Cormann, I think—although I will stand corrected as it may have been a previous speaker—objecting to that but in my home state of Tasmania the people seem very happy with what has happened and with how it is progressing. Nobody, in fact, has spoken to me in any negative way about it.
We have also given nurses and midwives access to Medicare and the PBS. I think it was Senator Feeney who mentioned that we have lifted the Leader of the Opposition’s old cap on GP training places and we are undertaking proper national planning for our health workforce. Having spent some time, previously, in the health workforce, I know that that action is greatly appreciated by people within the workforce. The Labor government are giving states incentives to reduce hospital times and, of course, we are always trying to improve elective surgery and emergency department waiting times.
We all know that Mr Abbott’s legacy of ripping $1 billion out of the hospitals, capping GP training places and leaving a shortfall of nurses has had a negative impact on the whole of the health area. It has resulted in workloads for the staff across the board, from nurses aids to doctors, being greater. Once again we see the opposition come into this chamber—in fact nearly every time I am in here—and carry on about how much money they think they have saved. But what they do not say is that they only saved money by not spending it or by cutting programs. By doing that they did a disservice to the people of Australia. They did not make life easier for people. They did not make life easier for any of the workforce in the hospitals by cutting $1 billion out of the health budget. Of course the opposition would have increased the cost of drugs by cutting the PBS and, once again, that would not have helped the people of Australia in any way, shape or form if it had happened.
We have always made it clear that we will not be signing any blank cheques, but health reform is an important part of what we have to do. We have taken that challenge on. Health is never easy. Having previously worked for a state government health minister, I understand the intricacies of trying to balance the health budget. It is never an easy budget to deal with. But we are dealing with human lives and with humans in some ways in a more important way than in some of the other areas. So it really is important that we get it right and that we fill the deficit that was left by those on the other side when they were in power in taking that money away. We help Australians get medical treatment when and where they need it with after hours GP services, GP superclinics. There are a few great new superclinics either already working or underway in my home state of Tasmania. The people of Tasmania greatly appreciate that those have been put there.
I rise to take note of answers by the Minister representing the Minister for Health and Ageing, Senator Ludwig, on health reform. It is interesting to note that ever since former Prime Minister Kevin Rudd and the Minister for Health and Ageing, Nicola Roxon, forced their historic health reform on the states it has been unravelling. Within days the then Prime Minister had to admit that, under his plans for activity based funding for all hospitals, hundreds of smaller mostly rural and regional hospitals would have to close. Having been involved with hospital boards in rural areas for a long time, I could not see where this Prime Minister or the health minister were going with their health plan. It really was not going to make sense practically. Within days Mr Rudd had to change the formula and promise that no hospital would close.
Then before the ink was dry on the COAG health reform agreement, secretly and quietly the Rudd government disposed of the national funding authority, one of the key parts of his reforms to provide transparency in health funding. This was raised very often in the lead-up to the election and it just disappeared because the states said it was not needed. Next, the diabetes plan was withdrawn. Doctors refused to have anything to do with it because of lack of consultation. Then we found that the local hospital networks were no such thing. Under the Rudd-Gillard reforms, local does not mean local, and I could speak for a great length of time on that position.
Then we had the Medicare locals. Those were supposedly to coordinate primary care. Leaked documents from New South Wales and Victoria show that even those Labor state governments had no idea what these bodies were meant to do, how they would operate and who would form them. Just a month into the new year before the historic Rudd-Gillard reforms are even a year old, key parts of them are being abandoned by the Prime Minister, Julia Gillard. At Monday’s COAG she is likely to dump the so-called reform plan for the Commonwealth to be the dominant funder of public hospitals. We hear that it will now be 40 per cent Commonwealth, 60 per cent states. I feel, too, that Prime Minister Gillard is likely to run away from the clawback of the GST from the states and this, of course, has been led very strongly by Premier Barnett from my home state of Western Australia.
Prime Minister Gillard is also likely to dump the four-hour waiting time targets for emergency departments—and who knows what else may disappear from Labor’s historic reforms. The slogan of federally funded and locally controlled that went with these so-called reforms is a joke. Ms Julia Gillard got rid of Mr Rudd because the Rudd-Gillard government had lost its way and the Rudd-less Gillard government has not found its way as far as health is concerned. Prime Minister Gillard is so desperate to give the perception that she can get a health reform deal that she will abandon any parts of the reform agreement necessary to get the premiers to sign up. We were really led to believe earlier on that the premiers had signed up to the GST and then we find later that this had not happened. So this is a very weak Prime Minister preparing to do a huge backflip. No-one knows what she stands for. She went to the last election saying the GST clawback by the Commonwealth to fund public hospitals was absolutely necessary. She gave a rock solid commitment to the GST arrangement. Now she is walking away from it. Almost a year after the agreement was done, no-one has signed off on its core principles.
Another bungle earlier this year which caused huge numbers of constituents to call or email my office was the health registration bungle. We had numerous health professionals—doctors, nurses and allied health people—not being able to register. The Australian Health Care Reform Alliance, which includes 50 organisations, had 70 people at their recent conference. Out of that summit came an agreement that there can be no real reform of the health system without primary care reform—that is, greater emphasis on early intervention and prevention and greater equity of access to doctors and other primary care providers with less overall emphasis being given to hospitals. Coming from a rural area, I think that is an essential component for the practicality of these health reforms. The reforms are about people. They are about patients. They are about access to health services.
Question agreed to.