This bill, the National Health Reform Amendment (National Health Performance Authority) Bill 2011, proposes to establish a statutory authority known as the National Health Performance Authority. It introduces amendments to the National Health and Hospitals Network Act 2011, which was only passed by the House on 21 March this year. The National Health and Hospitals Network Act establishes the Australian Commission on Safety and Quality in Health Care as an independent statutory authority. If enacted, this bill will amend the National Health and Hospitals Network Act 2011 by changing its title to the National Health Reform Act 2011. Still to come is further legislation which will establish a third statutory authority, the Independent Hospital Pricing Authority. When the initial bill was introduced last year, the coalition called for the government to make all provisions to establish all of these bodies at the one time. But, as usual with the government, what we have is a piecemeal approach of bill after bill and amendment after amendment.
It is worth recounting the history relating to this bill, the authority that it creates and the warnings and concerns that have been sounded loudly. It is an outstanding example of the ineptitude of this government. When the minister introduced the initial bill, the National Health and Hospitals Bill, in September last year, as with virtually anything this government attempts to do with health, it was described as 'historic' and as delivering on the government's health reform agenda. Of course, the so-called reform agenda was somewhat different back then. These were the Rudd-Roxon reforms and, as the minister told the House, they were all about the hospital networks that would be funded nationally and then run locally. At that time the current Prime Minister, Julia Gillard, was still on board with Kevin Rudd's reforms, telling the Committee for Economic Development of Australia in November last year:
From July 1, the Commonwealth's share of hospital funding will increase to sixty per cent … GST retention and dedication to health care will commence.
As with so many of this government's promises, that just did not happen. Julia Gillard earlier this year unceremoniously dumped the Rudd clawback of the GST and the commitment to the major funding of the public hospitals and is now going to provide only around 40 per cent of the public hospital funding. Yet in last year's election campaign the Prime Minister also stated:
… I regard health care as one of the greatest responsibilities of any government.
… … …
If my government is returned to office on August 21, I will pursue our national reforms until the job is done.
We all know that standing by commitments and promises to the Australian people is not high on this Prime Minister's list of achievements for her government. Her action in health is every bit as vigorous as the reversal of her promise that no government she led would introduce a carbon tax, a tax that Australian people do not want yet one that she steadfastly insists on inflicting on them by the middle of next year.
The National Health Performance Authority is to be charged with monitoring and reporting on the performance of local hospital networks, public and private hospitals, primary healthcare organisations and the bodies that provide health care services. It was to be an incredibly wide-ranging brief. Unfortunately, the bill provides absolutely no performance indicators that the proposed authority would monitor and report upon. It just sounds hard to fathom that a bill with such intense overtures has no performance indicators. The government controlled House of Representatives Standing Committee on Health and Ageing held an inquiry into this bill. There was one extremely brief public hearing for the Department of Health and Ageing to answer seemingly one question and a report from the committee was then tabled with one recommendation, that being for the House to pass the bill with a minor amendment requiring an annual report to the parliament.
Given that submissions to the inquiry outlined serious reservations regarding this legislation, coalition members presented a dissenting report that it would be unwise for the House to pass the legislation until stakeholder concerns were addressed. The dissenting report noted:
… there are far too many unanswered questions about the National Health Performance Authority … The House should not debate this bill until the Government clarifies …
matters. It also noted:
… a number of stakeholders that wanted to contribute to the Inquiry were unable to due to the haste with which the Inquiry was conducted.
This debate has been on the agenda for many months and to think that the process would have been rushed through is unthinkable, so it is worth looking at some of the detail of what the stakeholders said about this legislation. The explanatory memorandum to this legislation states that its measures will have no regulatory impact on business or individuals. However, the AMA bluntly responded, 'We do not believe that this is a true statement.'
The Australian Private Hospitals Association has concerns that this new authority will simply add 'yet another layer of compliance burden for both the public and private hospital sectors'. Its submission to the House committee inquiry stated that the national data collection must replace the current system of multiple reports to multiple government agencies which it says place 'a significant regulatory compliance burden' on private hospitals.
The bill was also the subject of a Senate committee inquiry. The Royal Australian College of General Practitioners warns that the provisions of this bill hold long-term threats. They will:
… harm the current high standard of medical services, and consequently health services, delivered to the community.
Catholic Health Australia held similar concerns in its submission to the Senate and stated:
The legislation as currently drafted is very broad – indeed vague – on the scope, range and detail of data that will be required to be submitted.
It wanted to see detail set out in the regulations that would enable the parliament to exercise oversight. It said such detail was needed to avoid unintended consequences. Looking at a particular incident in the UK, it said:
We need, for example, to learn from the recent experience of the Mid-Staffordshire NHS Trust in United Kingdom, where it has been reported that between 400 and 1200 excess deaths together with appalling lapses of patient care and hygiene occurred between 2005 and 2009 as a result of the local board and hospital management focusing more on meeting performance and cost cutting targets than on actual patient care.
The College of General Practitioners pointed out that it was unclear whether general practice will be monitored by the authority and clarity is needed on this issue.
Catholic Health Australia echoed many of those points and also called for clarity on the role of the authority, noting that the Australian Commission for Safety and Quality in Health Care, the Australian Institute of Health and Welfare and the Australian Bureau of Statistics already collect data on hospitals and health services. CHA also wanted the legislation drafted in such a way that the governance arrangements of the authority would reflect the makeup of the Australian health system and therefore would have members with knowledge of public and private hospitals, primary health care and private or non-government healthcare provisions. A submission to the Senate inquiry from the Council for Procedural Specialists queried the very need for the authority and said it could find 'no justification or compelling case as to why it is needed'.
There were recurring themes throughout many of the submissions to the House and Senate committees, namely, that there is a lack of clarity about this legislation and the authority it will establish, vagueness about what it will do, a lack of goals and objectives, concern about duplication with other new agencies this government is establishing and with existing agencies, worries about the administrative burden being placed on health service providers and concern about the composition of the authority board.
Predominantly, this bill tries to speak to the intent of giving power to the regions by having their own boards. However, the confronting reality is that the boards will neither have the power to make local decisions nor employ staff on a needs basis. This is just another expansion of Labor's overarching centralised policies which continually haunt the political landscape. This bill does not speak to decisive action on waiting rooms, yet it speaks to predetermined goals of 90 per cent of patients being treated within four hours. When I speak with my local practitioners, who are already under duress, some suggest these goals are laughable.
This bill gives no guarantees to people on waiting lists—at either my Beaudesert Hospital or the Gatton Hospital—that they are going to be treated any quicker. Introducing another layer of bureaucracy does not assist the frontline staff in meeting their day-to-day demands. These reforms are not patient focused and it would appear that the only focus of this government is to create a record number of bureaucrats in an already bloated public sector.
What we are looking for is flexibility for the people on the ground to be able to make decisions that impact on their workplace on a daily basis without having to deal with another layer of bureaucracy, without having to deal with a regional body that could be based hundreds of kilometres away and without having to play second fiddle to larger hospitals that will have their own priority lists. Once more, regional Australia will be left out in the cold.
As I have alluded to in my speech, too many of the peak body groups are starting to lose confidence in this system. More changes at the top, increased bureaucracy and unanswered questions ultimately end up producing fewer results on the ground.