Health Services: Government Performance

Written on the 14 November 2012

I am pleased to speak on Mr Jennings's motion which states:


That this house notes that two years after being elected the Baillieu-Ryan government has failed Victoria in health service development and further notes its actions in shutting down scrutiny of health services in Victoria.



At the outset I have to refer to Ms Hartland's comments about the previous government's track record of criticising the then opposition over the 11 years Labor was in power and the blame game that went on.


It also used to drive me, to use her phrase, batty that Labor members blamed the Kennett government. Sometimes the issues Labor members were talking about happened 15 or 16 years earlier. Many of the health reforms made by the Kennett government in the early 1990s have stood the health system in this state in good stead. That casemix model is now being looked at from a commonwealth perspective across the nation. There were some very good initiatives.


I do not want to go too far on the blame game train, and obviously I was not a member of the opposition at the time, but I want to point out some aspects of what this government found on coming into government and particularly the projects referred to by Mr Jennings in his contribution to the debate. I cannot let this opportunity pass without referring to the Auditor-General's report in October on the miserable failings of the previous government's administration of a whole range of projects. It was really a debacle.


We know what those projects were. There is myki and the desalination plant, which will cost Victorians $1.8 million a day for the next 27-plus years. These are legacies that we are dealing with. There is the Melbourne wholesale market project in my area of Southern Metropolitan Region and the Princes Pier project, which has a four-year overrun. These projects are costing huge amounts of money, millions of dollars in overruns, and they were under the administration of the previous government. It had 11 years of enormous income and did very little in terms of planning.


There has been a significant population increase in this state over the period of the Labor government and now into this government's term. It is encouraging for all Victorians to know that we live in a fantastic state. We live in the most livable city in the world, and that is something of which all Victorians can be very proud.


However, the planning challenges are significant in relation to the numbers of people who are needing hospital services in our cities -- as well as in our regional areas -- and putting an extra burden on those health services. Very little planning was done to take into consideration the enormous numbers of people that have come to the state over the past decade or so.
I know Ms Hartland is passionate about health service delivery. She brings up a lot of issues about health-care delivery, and in many respects they are also issues of concern for me because I worked in the public health sector, especially on the front line in service delivery, for 14-plus years. Those issues are significant. Our doctors and nurses in the public health sector do a tremendous job. There is no question about that. It is challenging, difficult and often unpredictable. The nature of health is that it is complex and unpredictable. There are certain things that we can do, should do and can do much better. However, it takes a lot of planning and a lot of support for our health services. As we have an ageing population and the complex health needs will be ever-increasing for that particular cohort of people, the demands on our health services are only going to increase.


I think it is imperative that governments support health-care services, and I want to get to the recent midyear economic outlook in relation to what the federal government has done to our Victorian health services, which will have a major impact for the end consumer -- that is, the patient. In Victoria we have lost $50 million in commonwealth funding for elective surgery and $6.1 billion in GST revenue, and we know there are going to be changes to the private health insurance scheme at a federal level. I think that is absolutely damning.


Mr Ramsay -- Shame!


Ms CROZIER -- There are so many people on low to middle incomes who rely on private health insurance, and they will be severely affected by the changes being made by the federal government. As Mr Ramsay has just interjected, I think it is an absolute shame. People have the right to choose their health-care services. I am very much of the view that public health services are there for those who are in most need and most vulnerable, and we need to support that. One way to put extra pressure and burden on those health services is to rip out private health insurance funding. As I said and I want to reiterate, it will have an enormous impact on our public hospitals and public health services right across the state.


Mention has been made of the carbon tax, and I also want to make mention of that.


The simple fact is that our hospitals and health services are not getting any compensation from the federal government. It is not giving health services any compensation in relation to the carbon tax impost that will be applied across our public hospitals and health services, and of course our private hospitals also will be hit. We know that hospitals are very energy intensive. I have spoken about this issue in the past. Whether it be in our intensive care units, our emergency departments, the linen aspects, our operating theatres or just in the general running, a hospital does not shut down. It is a very energy intensive institution and facility, and the carbon tax will have an impact. There is not a shadow of a doubt about that.


The Alfred hospital and Monash Medical Centre are both in my area of Southern Metropolitan Region, and my constituents access those two very large public health institutions.


The carbon tax will have a $660 000 direct hit on the Monash Medical Centre, and the Alfred hospital will have a $700 000 carbon tax impost. That has to impact on service delivery to those patients. I have said in the past that it is the consumer who will be affected, and in this instance the consumer is the patient. The money has got to come from somewhere, and it will be ripped out of those services. I think it is absolutely shameful that the federal government is putting those extra burdens on Victorian health services and ultimately Victorian patients.


As I mentioned at the outset, the commonwealth's midyear economic update will also have a major impact on health service delivery in Victoria, with $435 million having been cut from the national health reform agreement over the next four years, including $67.1 million cut in 2012-13 and $230 million cut from Victorian dental funding -- dental funding has been mentioned and these are real examples of where federal funding cuts will have an impact on service delivery to so many people who require those services.


In addition, the commonwealth has made further changes to the private health insurance scheme, which I have talked about. As I said at the outset, that is going to place an additional burden on our public health services, and more and more people are going to end up waiting for surgery, outpatient services or even the ability to access appropriate health services across Victoria.


The Minister for Health has said -- and he has argued this very strongly -- that those commonwealth cuts have been justified by a revision of population growth forecasts, and I think that is an extraordinary excuse. We know that the federal government is desperate to deliver a surplus. There has been no revenue from the so-called mining tax, and the federal Treasurer, Wayne Swan, is absolutely desperate, so they are looking for savings and are ripping money out of state budgets across the nation. In terms of the best interests of Victorian patients, I think what they are doing is absolutely deplorable. In contrast, Minister Davis has been arguing very strongly about those points, and I think he has made the case at a local level here in Victoria but also at a national level. He has argued very aptly for Victorian patients and Victorian health services.


In relation to those cuts that have been attributed to us, this year's Victorian budget showed a significant spend on health to maintain our services. In the 2012-13 financial year there will be $13.7 billion for total health expenditure. That represents a $618 million increase in health expenditure over and above last year's spending, so this government has put significant additional money into Victorian health services. This also represents a $376 million increase in acute health expenditure over and above last year, so I think that to say the minister is missing in action and not doing anything for Victorian health services, and to apply that across the board, is, to say the least, quite inaccurate.


As we all know, it is a complex area. I am pleased to say that the minister has taken it very seriously and has put a lot of additional money into the areas which need it. I am pleased there has been an increase of $883 million over four years in acute health expenditure, with $603.5 million to increase the capacity of our hospitals and support demand growth. There is an extra $44 million to maintain elective surgery capacity, and that is to partly fulfil a lapse in commonwealth funding.


Ongoing elective surgery has been allocated an additional $149.68 million. The organ retrieval and transplantation program is a very complex area that needs ongoing funding, not just acute and immediate attention when a situation arises, because there is an ongoing cost to recipients. I am pleased that an additional $21 million has been allocated to that health area.


In addition to all of those aspects, Mr Jennings talked about regional areas not receiving enough attention -- I cannot quite recall the words he used. However, I am pleased to say that there has been $46 million allocated to provide extra beds at Ballarat base hospital, which honours an election commitment -- --


Mr Ramsay -- And a helipad.


Ms CROZIER -- And a helipad, and Mr Ramsay will speak on that in more detail; I am sure his constituents in the Western Victoria Region are very happy with that outcome. It gives them access to metropolitan services in a far more timely manner. Anyone who has lived in the outer areas of Victoria knows how difficult it is to access an ambulance and get to major centres. As somebody who has worked in a country hospital in regional Victoria and seen some severe emergencies, I know only too well how much that helipad will benefit people living around Ballarat and in Western Victoria Region.


Ms Hartland spoke about maternity services, and she was referring specifically to the western metropolitan area. As somebody who has worked in that area, I am very aware of the ongoing demands. I think it is a good sign that with all the new babies we have a bit of a population explosion, but maternity services are an area of concern. I know $15 million has been put into the Sunshine Hospital intensive care unit to expand maternity services in the area.


If Mr Elsbury were in the chamber, he might correct me, but I think the hospital was used as a film studio under the previous regime. So we can be proud of what we are doing: delivering services rather than filming a program that is not going to deliver one extra health service to Victorian patients, particularly in Ms Hartland's electorate of Western Metropolitan Region.


There are many other ongoing projects, and the coalition government should be very pleased with what it is doing. The floods in northern Victoria had a major impact on services there. They were an untoward circumstance that occurred at that time. The Charlton hospital needed to be rebuilt, and $23 million has been put aside to co-fund that rebuild with the commonwealth. That demonstrates a huge commitment on the part of this government to honour areas that are in need. There are many other examples of specific projects that are under way.


Over and above all of those areas, there is $100 million over four years to establish the Victorian Innovation, e-Health and Communications Technology Fund to support IT services across the health system. Again this has been a long running issue. We know that under the previous government the IT project HealthSMART was a complete debacle. This area is evolving all the time. It is necessary to get it right because IT is going to play a critical role in the delivery of health services not only immediately but into the future. I am pleased that a significant amount of money is being allocated towards it and that there is acknowledgement of this important area for the delivery of health services.


Returning to the Minister for Health's advocacy, Mr Jennings made reference to the minister being an inadequate advocate. That is very far from the truth.


Mr Jennings -- How hard it was to say that!


Ms CROZIER -- I have to say, Mr Jennings, that only a few days ago -- --


The ACTING PRESIDENT (Ms Pennicuik) -- Order! This is about the fourth time Ms Crozier has addressed a member, such as Ms Hartland and Mr Jennings, across the chamber. This is a very gentle reminder for her to speak through the Chair.


Ms CROZIER -- Thank you for the reminder, Acting President; I will direct my comments through you in future. I was getting carried away by Mr Jennings's use of language when he called the Minister for Health an 'inadequate advocate' for Victorian health services and Victorian patients. We saw the minister's advocacy demonstrated only a few days ago on 9 November at the Standing Council of Health meeting where all six state health ministers collectively expressed concern about the reduction in commonwealth hospital funding, its impact, the basis for the decision and the lack of any consultation prior to that decision being made. It is an absolute indictment of the federal government and the federal health minister to have no consultation at all in relation to these very crucial issues, especially when you are dealing with the area of health-care delivery and services and what those cuts are going to mean to Victorian patients.


As I have mentioned before in this house, those cuts are significant. They total $107 million, made up of $39.7 million from 2011-12 and $67 million from 2012-13. The reduced commonwealth contribution paid directly to hospitals is scheduled to start on 7 December of this year, which is only a few weeks away.


That is significant because we are halfway through this financial year, and if those cuts are applied, they are going to have a huge impact on services in Victoria.


What does that mean, and what does that look like? It means less beds, less nurses, less doctors, less outpatient services, less operations and less health service delivery right across every hospital and every health service in the state. That cannot be understated. These cuts would have an impact that would reflect poorly on health service delivery here in Victoria if they were to go ahead. The only people to blame are those in the federal government and the federal Minister for Health, Tanya Plibersek, who has been absolutely silent on this issue and has not listened to the six state health ministers.


The position of the six state health ministers is outlined in a communique of the Australian Healthcare and Hospitals Association, which reads:


The state health ministers noted that the determination relating to the downward revision of the national specific purpose payments for health care was not made by the federal Minister for Health.



State health ministers expressed concern about the reduction in commonwealth health funding changes, which has resulted in: retrospective and future reductions to state funding, which will seriously impact on state budgets that have already been set; the factual basis of the decision relies on disputed population figures.


Concerns were raised about the lack of any consultation with states and territories prior to the decision.



State health ministers urged that the heads of Treasury convene urgently to discuss the commonwealth Treasurer's determination and report on the basis of this decision.
That is not one minister; that is not the Victorian Minister for Health; that is six state health ministers all coming to that conclusion. If they are coming to that conclusion, the federal government and the federal Minister for Health have an absolute obligation to justify that position. They should not go ahead with the cuts, because they are going to have significant impacts. From Southern Metropolitan Region I will use the example of Southern Health again, where there would be a reduction of $13.7 million. That is in addition to the carbon tax impost and the other costs it is constantly facing. It is an indictment of the federal government. Alfred Health would have a reduction of $7.9 million.


They are enormous figures, and they go to the bottom line of how those two bodies can deliver health services to not only their local patients but also Victorian patients in general who come under their broader responsibility. The commonwealth should be condemned for that.


In conclusion, we will not be supporting Mr Jennings's motion. I say again that the federal government should be reviewing all those cuts and listening to the six state health ministers, who have put their argument very succinctly.



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