The National Health Amendment Aids Payment Scheme) Bill 2010

June 17, 2010

The Continence Aids Assistance Scheme has proven to be very important in providing the supplies needed to allow people affected by incontinence to live with dignity. Incontinence is a subject that is rarely discussed, despite it affecting a significant number of Australians. Incontinence affects up to four million Australians of varying ages and for a variety of reasons.

According to the Continence Foundation of Australia, incontinence affects 20 per cent of Australian men and 37 per cent of Australian women. For many people, this condition is embarrassing and inconvenient. The Continence Aids Assistance Scheme helps to pay for the supplies needed to allow people to manage incontinence. Under the current scheme, eligible people with severe and permanent incontinence may receive up to $489.95 in incontinence products. The products are supplied by a sole provider on behalf of the Department of Health and Ageing.

The National Health Amendment Continence Aids Payment Scheme) Bill 2010 , which is before the House today, will allow the Minister for Health and Ageing to formulate a scheme to provide direct payments to eligible persons as a contribution towards the cost of incontinence products. Medicare will administer the new scheme, which is to be called the Continence Aids Payments Scheme, or CAP Scheme. The CAP Scheme is intended to give recipients more flexibility and choice and to promote competition. The bill also provides for a transition period to allow people currently under the CAAS to move smoothly onto the CAP Scheme. Given the Rudd government’s track record in service delivery, I very much doubt that the transition will be as smooth as the minister would have us believe.

As a principle, the opposition supports measures that increase competition and that allow individuals to take greater control of their own lives. For many people, this change will be positive. However, I have recently been contacted by a group of local incontinence advisers and stomal therapy nurses who are concerned about the changes. The nurses are mainly concerned that the money provided under the CAP Scheme may not in some cases be spent on incontinence aids. The nurses are also concerned that the changes may lead to some people purchasing incorrect or inappropriate products for their individual circumstances, leading to an increased risk of falls or infections. The nurses also expressed concern about the increased stress and cost for carers who are responsible for managing a person’s access to incontinence products.

There are also questions about whether the new CAP Scheme will make it more difficult for people to access the New South Wales Program of Appliances for Disabled People. Under the current arrangements, people who are living in New South Wales can access help through the state system once they have exhausted their allowance from the Australian government. The new CAP Scheme will make it more difficult to determine when someone has used their entire entitlement from the Commonwealth and it has the potential to result in some people being denied access to the state system for a period once they have used up their allowance from the Commonwealth. My office has been in contact with the North Coast Area Health Service for advice about how the new CAP Scheme will interact with the New South Wales system. I have been told that the details are yet to be worked out.

With the scheme to come into operation shortly, we have a situation where the details are yet to be sorted out. I must say that this government has proven itself not to be good at paying attention to detail. In the overall scheme of the national health budget, this is a relatively minor program worth around $40 million each year, but lack of attention to the detail of this program is not isolated and is being repeated around my electorate. In the Cowper electorate, we have Coffs Harbour Health Campus and Kempsey District Hospital, plus hospitals at Maclean, Bellingen and Macksville and a multipurpose facility at Dorrigo. In the smaller hospitals, we have seen the North Coast Area Health Service continue to downgrade services and cut resources from smaller facilities. This has not only outraged residents from smaller communities but also placed extra pressure on the larger campuses, such as Coffs Harbour, as more patients are transferred there for treatment or care.

I take this opportunity to acknowledge the great work of local communities who support their hospitals in Bellingen, Maclean, Kempsey, Macksville, Coffs Harbour and Dorrigo. In Bellingen, the Bellingen Health Action Group is very active and very supportive of their local hospital. I recently organised a meeting between the shadow parliamentary secretary for rural health, Dr Andrew Southcott, and the Bellingen hospital support group. Attending the meeting were Barbara Moore, Fiona Crosskill and Solvieg Larsen from the action group, Dr Deidre Little from the medical staff council, Mayor Mark Troy and council general manager Mike Colreavy. I also joined the Bellingen community in a public rally about the hospital on 15 May.

The Bellingen group is genuinely concerned about the ongoing downgrade of services at its local hospital. In recent years we have seen maternity services withdrawn and the executive officer and director of nursing positions scrapped. There have also been ongoing concerns about plans to close the accident and emergency ward from 11 pm until 7 am. That is despite the fact that the emergency department in Bellingen handles around 30 emergencies each year involving triage 1 or triage 2 patients. Such cases require immediate treatment and therefore should not be delayed because the patient has to get to the Coffs Harbour Health Campus some 30 minutes away. As one of the hospital action group members said to me recently, these are lives that could have otherwise been lost.

In the past few weeks, the North Coast Area Health Service have pledged not to close the emergency department at night and have flagged that they will restore maternity services. However, whilst these words are welcome, the Bellingen community knows that the fight is not over. Too often in the past we have had plenty of promises but very little action. The removal of maternity services at the hospital has highlighted how the area health service can say one thing and do the complete opposite. At Bellingen we have seen out-of-hours and on-call X-ray services cancelled and the use of the operating theatre severely cut back. The cutbacks and downgrading of services has had a spiral effect on the training and skills base of the staff. In the end, staff may have had no choice but to resign or seek work elsewhere.

The treatment of the Bellingen community by the local area health service has been nothing short of deplorable. The bottom line with Bellingen hospital is that the Bellingen shire is flood prone. Last year was enormously challenging, with up to six floods in the Bellingen local government area. In many cases, Bellingen was cut off from Coffs Harbour. Having adequate health services at Bellingen hospital was therefore vital to treat those who needed medical assistance.

The Bellingen River District Hospital services the Bellingen Valley and Dorrigo communities. For more than 108 years, it has done so in an excellent manner, but despite the growing population services are being eroded. Given the changes to the health system which this government has announced, the very least it could do is to ensure that there are no further services cut or positions abolished. Only last week, there were media reports that a further 80 jobs were being cut across the North Coast Area Health Service. That is why there is real concern that the Rudd government has come up with a political fix rather than reforms that will genuinely improve health services on the North Coast.

Recently I called for an immediate cessation of ongoing costcutting in hospitals across the North Coast until the Rudd government explains how health services in the region will be managed in the future. It is clear that local communities are scared about what these changes mean for smaller hospitals. They are worried that the North Coast Area Health Service will continue to slash services and sack staff and that the proposed new hospital networks will only disadvantage smaller health facilities. If these proposed new networks are going to deliver better outcomes for regional communities, the slashing and burning must cease. That is why I join the Bellingen Hospital Action Group and remain vigilant to ensure vital services are restored and that there are no further downgrades, regardless of what the North Coast Area Health Service says.

June 17, 2010

I know the North Coast community is also concerned that the Prime Minister’s health package is going to do nothing more than add another layer of bureaucracy. The recent federal budget set aside an additional $500 million for bureaucrats, which means an expanded federal layer of administration. That is more expenditure on desks than on beds. Instead of investing in beds, the government is investing in desks. Regardless of what the Prime Minister says, we must remember that under his new health agreement state governments retain control of the health-funding pool. We all know that it is the poor management of public hospitals by the state government which is the real reason why health services in New South Wales have descended into such a parlous state. One must question whether this new agreement will actually deliver meaningful outcomes on the ground or whether we are going to see more waste and more mismanagement.

I previously touched on the downgrading of Bellingen hospital and its flow-on effect to the workload at Coffs Harbour Health Campus. Almost every day there is a shortage of beds at the Coffs Harbour Health Campus. One of the main reasons for this is that patients are not being treated at their local hospital but rather are being transferred to Coffs Harbour. As a result, the Coffs Harbour Health Campus is bursting at the seams and there is a lack of beds in the medical wards. This flows back into the emergency department where waiting times continue to blow out because the emergency department has nowhere to transfer treated patients. Doctors and nurses are being asked to do more with less and that places unsustainable pressure on our medical staff. In the end, patient care is suffering despite the best efforts of that very dedicated staff.

One of the problems with the health bureaucracy is that they are quick to reject statistics and figures which are presented to them by hospital medical professionals, but at the same time they will embrace their own data if it provides some justification for reducing investment in services. For some time now the nurses at Kempsey District Hospital have put forward a logical case, supported by strong statistical evidence, that their emergency department should have an additional registered nurse on each shift. In recent weeks the local area health service has at least acknowledged the problem, but I believe the House should be made aware of the long battle which these nurses have endured just to get to this point.

The Kempsey nurses have produced evidence which shows they are not receiving resources which reflect the number of presentations in the emergency department. I acknowledge the work of nurses such as Di Lohman, Jennifer Clarke, Jo Hensler and Linda Weir. I also acknowledge the tireless support of Mayor John Bowell, who has been an active supporter of the hospital for many years. Collectively, these people, along with many other colleagues, do a great job in representing the interests of health services in the Macleay Valley. The North Coast Area Health Service and the Minister for Health and Ageing have consistently ignored these people, despite the strong case that has been put. The area health service is guilty of treating Kempsey as a poor cousin of the Port Macquarie Base Hospital. In Kempsey, the nurses have comparisons of their hospital with similar hospitals where the difference in the number of presentations is 20 per cent yet the difference in the level of resourcing is 300 per cent.

(Resumed June 21, 2010)

I welcome the opportunity to again speak on this important bill, the National Health Amendment Continence Aids Payment Scheme) Bill 2010. I will add to my earlier remarks. I tendered that many of the presentations to Kempsey hospital were complex and involved mental health issues and violence. I know this is not unique in emergency department terms, but this puts extra pressure on the doctors and nurses in Kempsey. Kempsey hospital services a large area that stretches from Millbank in the upper Macleay across to South West Rocks and down to Crescent Head. It is a huge area, and it is important that the services are maintained and not eroded. I have supported public rallies which the Kempsey nurses have hosted and have shared the frustration and anger they feel towards the bureaucrats and ministers who continue to reject their case for more resources.

The recent acknowledgment by the North Coast Area Health Service that the nurses may have a case is welcome. A review—one of the endless reviews—is taking place and that is indeed long overdue. But there is no excuse for the way Kempsey nurses have been treated in this matter. I, like the Macleay community, will remain vigilant on this matter until Kempsey hospital secures the additional resources required for the emergency department.

There is not a hospital on the North Coast that has stronger community support than the Maclean District Hospital. Whether it be the hospital auxiliary or the local community, lower Clarence residents understand the importance of supporting their local hospital. But there is little doubt that the lower Clarence residents have, over time, been treated as second-class citizens by health bureaucrats. In 2007 the North Coast Area Health Service sold some land next to the Maclean hospital. Local residents thought the funds raised would be invested in upgrading infrastructure in Maclean—but, no, the North Coast Area Health Service decided instead to upgrade the emergency department in Grafton. In 2008 the NCAHS tried to sell more land adjacent to the Maclean hospital, but the community outcry eventually ensured there was little interest in the land and the area health service took it off the market. Slowly but surely the North Coast Area Health Service has been withdrawing resources from Maclean hospital. The hospital no longer has its own executive officer in charge, and a security guard’s position has been axed. Once again, the smaller hospitals are being screwed of every last dollar as services are centralised to larger regional hospitals.

Many of the concerns which I have detailed with regard to the above hospital also apply to Macksville Hospital. Macksville Hospital now has to share a director of nursing and an executive officer with Bellingen Hospital. Staff at Macksville Hospital do a great job in providing services to the Nambucca Shire but they have no choice now but to refer many cases to Coffs Harbour, which is 50 minutes drive away.

I would like to bring the parliament’s attention some comments that the federal member for Page has recently made. In the Northern Star newspaper the member for Page made the following comments in relation to provision of dental care:

These comments were made in a letter to the editor, so I do not think they were made in the heat of the moment but I do believe that she was not telling the gospel truth. Firstly, the Howard government did not scrap the dental health scheme in 1992—Paul Keating was our Prime Minister in 1992. But, more importantly, the Rudd government has been intent on scrapping the Howard government’s dental program. This scheme allowed people with chronic and complex health problems, where dental health was a contributing factor, to receive up to $4,250 over two years for dental therapies.

The federal Minister for Health and Ageing claimed in parliament that the program had only helped 15,000 people in four years. However, Ms Gay Santiago, acting assistant secretary of the primary care financing branch of the Department of Health and Ageing has told a Senate estimates hearing that the scheme provided 311,943 services between November 2007 and 30 April 2008. These services are vital for those who have the most genuine need for major dental work yet the Rudd government, including the federal member for Page, are willing to turn their backs on their people and it seems they are most willing to bend the truth when presenting their case.

Whether we speak about this legislation today or whether we debate the broader implications of the Rudd government’s approach to health, the real concern here is that the Prime Minister’s focus is not so much on people but on politics. This is why quite often the government falls short when we look at the detail. We should never forget that health is not about headlines, it is about human beings. Politicians like the Prime Minister who dress up new health agreements as a major reform but fail to provide meaningful detail are treating Australians with contempt. The details of health policy are the difference between health and illness, between help and despair, between dignity and embarrassment and, in extreme cases, between life and death. The opposition cautiously welcomes the government’s changes to the CAAS program but we will continue to scrutinise the government’s every move in the health portfolio. They have a track record of failure rather than success on everything they touch.

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