Australian National Preventive Health Agency (Abolition) Bill 2014

I rise like many of my colleagues to oppose the Australian National Preventive Health Agency (Abolition) Bill 201. Abolishing the Australian National Preventive Health Agency is a retrograde step but, sadly, is typical of this government's actions when it comes to health. It makes a huge case about the long-term costs of health for our ageing population—to justify cuts to spending—but fails to understand the old adage 'a stitch in time saves nine'.

Minister Dutton, the member for Dickson, has regaled us almost daily about a lack of frontline services in health spending like a tone deaf harpsichord player—discordant, aggressive and meaningless—and not just tone deaf but deaf to any voice but his own. Most alarmingly, the minister seems to be deaf to experts.

When Labor introduced the Australian National Preventive Health Agency, it did so with advice from the National Heart Foundation, the Public Health Association and the Royal Australasian College of Physicians. Labor established the Australian National Preventive Health Agency with an eye on health outcomes and an eye on the rising costs of health care in this country. It did so because preventative health care is a sensible way to keep our community healthy and to reduce costly hospital and specialist treatments. In stark contrast, the 'minister for a less-healthy Australia', introduces this legislation and shows a decided lack of understanding and vision for a healthy Australia.

The National Preventive Health Agency was established to take a national leadership role in preventative health, to coordinate, analyse and advise on key statistics and data in relation to chronic disease and prevention, to deliver and administer a preventative health research fund and to look closely at data to inform health strategies that will (a) improve health and (b) reduce the costs of health care into the future.

Data provided by the Australian Institute of Health and Welfare tells us that the 672,000 hospital admissions in 2011-12 could have been avoided if we invested in primary care. This number includes selected chronic conditions: 38,500 with asthma, 51,000 with congestive heart failure, 68,000 with chronic obstructive pulmonary disease and 87,000 with diabetes.

Data like that from the OECD in 2009 tells us that our hospitalisation rates are among the world's highest. They are higher than the OECD average, higher than those in the US and the UK and double the rate in Canada. Data provided by the Royal Australian College of General Practitioners in 2014 tells us that GPs provide comparatively cheap primary care: antenatal care with a GP costs $47 and at a hospital $223; a sexual health visit at a GP could cost $70 and at a hospital $253; vivisection for a GP costs $73 and at a hospital $438; a skin biopsy at the GP would cost $63 and at a hospital $289; and, wound management at a GP would cost $36 and at a hospital $162.

To date, this task has been undertaken with great professionalism and the links developed to health services across Australia have been invaluable. I know in my electorate, where diabetes, obesity, kidney, dental and eye health problems are prevalent, the relationships established through the Medicare Local, the GP superclinic, the headspace centre, ISIS Primary Care, private GP's and the Mercy Hospital have been terrific—all critically working together to improve health outcomes and the impact was flowing through. All this hard work could now be lost.

The Labor government knew the value of preventative health and supported the health system with services like those I just mentioned. We built GP superclinics, we established Medicare Locals, we funded headspace centres and, through national health agreements, we provided much-needed funds to hospitals for infrastructure.

In contrast, this government has no positive future plans for health services and this repeal bill is one small demonstration of that fact. In fact, I am having trouble working out what it is that the Abbott government ministers will being doing with their time, given the number of programs they have cut and the agencies they plan to abolish or amalgamate. Why would a government have such a short-sighted approach? A quick fix on the bottom line for the next year will result in an extra burden being placed on the health system in the future. It just makes no sense.

Why would a government and a health minister attack important efforts in preventive health? We see it again today in an article in TheDaily Telegraph trivialising the work in the preventative health sphere. We have heard members opposite speak of this today. The ANPHA funded the promotion of the My Quit Buddy app at Summernats, an event that attracts over 100,000 men who are principally 25 to 40 years old—a target group which is difficult to get to take health seriously and a core target audience for the National Tobacco Campaign. The campaign clearly had an effect with 55,000 downloads of the app at Summernats in January, compared with 19,000 in the month prior—a threefold increase in one month.

One of the most fundamental mistakes of policymakers is to try and make change from the top without bringing the sector with you and to make change without the active engagement of third parties. I have seen this in education and it is logically the case for health policy. The way this government has approached health initiatives in this budget is to focus more on running it as a business, rather than looking at how you achieve reform to the health system and how efficiencies translate into better care and improved health outcomes.

I heard of a case recently in my electorate where a local hospital emergency ward doctor spent six hours on the phone trying to secure a patient transfer, six hours he could have spent treating other patients. There must be a way to ensure efficiencies. I do not know the details of this patient's health issue but perhaps a well-resourced preventative health service may have avoided his emergency room visit in the first place.

The only thing this government appears to have tried to achieve in this budget is savings and the government appears to want to achieve those savings with little care or consideration for what the effect will be. The savings the government appears determined to achieve will hit at every level of the system: with this bill and the resulting cuts to preventive health programs, by imposing barriers to accessing primary care through additional out-of-pocket costs, by increasing the cost of medicines, by freezing rebates for specialist services and, of course, by cutting billions of dollars from the hospital system and public dental services.

These are not sensible savings; they are not savings that are reinvested back into strengthening Medicare or providing better access to services.

The intention to charge for GP visits, including for those that have to this point been bulk billed, is such an inequitable measure, as it actually provides a disincentive for GPs to bulk bill. And of course it is a solution based on a problem that does not exist. Australia does not have a higher level of GP consultations than the OECD average. With our ageing population and increasing rates of obesity, diabetes and heart disease, the Preventive Health Agency was rightly focused on measures that keep the population healthy and out of hospital. This is not what the changes proposed by this government will do. They will damage the system and not only stall the advances we have made but take health outcomes back decades.

In my electorate of Lalor we are well served by Mercy Health. However, this service was designed for an estimated population of 90,000. We will hit 200,000 people next month, and this government has no plans for the growth of that service—no plans to extend services in this high-growth area and only punitive measures taking away existing services. I will not and cannot support the erosion of Medicare, in any of the forms the government is trying, whether it be the GP tax, increasing the cost of medicines or cutting funding to public hospitals. I am and remain very concerned about the government intentions in relation to private health insurance and primary care. I want to support more funding for medical research, but not off the back of taxing people when they are sick.

I watched with interest as Labor introduced many health reforms in the previous two parliaments. Labor in government embarked on a substantial period of health reform through the health and hospitals reform process. I saw the hard work, firstly of Nicola Roxon and then of Tanya Plibersek, to secure these agreements with the states. These were great achievements, and there were other milestones. We achieved things like the highest rate of bulk billing in Medicare's history; more in public hospitals, with the establishment of new efficient mechanisms to start to fund them into the future; heavy investment in new medical research facilities; new cancer centres in our regions; the establishment of e-health systems; upgrades and new integrated GP clinics; primary and community health centres; and Aboriginal medical services, to name a few.

Labor established Medicare Locals to provide a mechanism to directly support the integration between primary care and hospitals, to close gaps in service delivery and to address population health issues at the local level. I meet regularly with the team from the South Western Melbourne Medicare Local and am always impressed with the hard work and dedication of the team. And when I meet with other local health service providers, even those who were sceptical at first, they now sing the praises of this Labor initiative.

It is worth noting again that the cuts to health by this government are ill advised and will hurt the Australian population in the short and long term—and it is not just Labor saying this. This month's editorial in the Medical Journal of Australia also says so and makes some very salient points. I quote:

The direct effects of the proposed federal Budget on prevention include cuts to funding for the National Partnership Agreement on Preventive Health, loss of much of the money previously administered through the now defunct—
soon to be defunct—

Australian National Preventive Health Agency, and reductions in social media campaigns, for example, on smoking cessation.
The editorial also made the point that the $7 GP tax will more likely be a $14 co-payment for those with chronic illness, because they generally include a test. It says clearly:

The effects of these copayments on preventive behaviour are greatest among those who can least afford the additional costs
It goes on:

The potential for prevention is greatest among poorer patients, who are often at a health disadvantage.
The journal made this salient point about preventative health and cuts to hospital services:

The greatest pity of all is that the proposed cuts to funding for health come at the time when the first evidence is at hand of potential benefits of the large-scale preventive programs implemented under the national partnership agreements. A slowing in the rate of increase in childhood obesity and reductions in smoking rates among Indigenous populations have been hard-won achievements.
Hard won achievements but not worth pursuing, according to this government.

I believe preventative health measures should not be a pawn in a budget game. They should be embedded in health policy and funded appropriately. A government serious about people being fit for work until they are 70 should be seriously investing more in preventing chronic disease, not less. Labor opposes this bill for the short-sightedness that it demonstrates in relation to the key priorities facing Australian's health today and for the lack of vision the government has in relation to understanding the challenges facing the health system into the future. Labor is also opposed to the government's callous decision to cut preventative health funding to the states and territories for work in increasing physical activity and improving nutrition and healthy eating and for support smoking cessation and reduction of harmful alcohol consumption in communities around Australia.

We often hear those opposite complaining that we on this side are whingeing. We heard it again today. We are not whingeing, and neither are the people who will be hurt by this bill—now and into the future. We are rightly pointing out the disastrous impacts the government changes will have on this country. We are responding to real people's concerns and the concerns of the health experts in this country. We are responding to real people's requests that we oppose the government changes that will negatively impact on health outcomes and the long-term cost of health care in this country.

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