BILLS (Second Reading): Health Insurance Amendment (Prescribed Fees) Bill 2021

12 May 2021

The Health Insurance Amendment (Prescribed Fees) Bill 2021 simplifies the administrative processes for the recognition of specialists and consultant physicians by Medicare under the Health Insurance Act. It does this by removing the prescribed fee of $30. As the member for Hindmarsh and other speakers have noted, the current pathway in the act to recognise a specialist or a consultant physician requires a medical practitioner who has gained fellowship with a specialist medical college to apply to Services Australia for access to higher Medicare rebates. As part of this process, a medical practitioner is required to pay a prescribed fee of $30 via cheque or money order. One wonders how we got so out of date that this is still the process. Rather than just being out of date, this method of payment became difficult during the COVID-19 crisis and in particular during movement restrictions. This had a massive impact on specialist and consultant physician recognition for the purpose of Medicare.

The government explored the option of implementing more modern payment methods for these fees but the costs of such an upgrade were assessed as far greater than the loss in revenue from scrapping the fee. As a result, the government has elected to remove the fee entirely, which this bill gives effect to. Labor supports this measure as it will remove a barrier to better building the specialist medical workforce that Australia needs. But, again, how tiny a tweak is this. After eight long years of Liberal government, this, unfortunately, is the type of reform that we get.

Let's be clear, the government have failed on their two jobs with regard to health care this year. The first was the speedy, effective rollout of the vaccine; and the second was a safe, national quarantine system to protect returning Australians during the vaccine rollout. This government and this Prime Minister are failing on both measures. The Prime Minister has said that the vaccine rollout, in his words, 'is not a race'. Well, I disagree. It actually is the race of our lives. You cannot have a first-rate economic recovery with a third-rate vaccine rollout. This government has missed every target it has set. The Prime Minister promised four million Australians would be vaccinated by the end of March. After failing that target, the government's next target was six million Australians vaccinated by 10 May. With only just over 2.5 million vaccinations completed, 1.7 million of which have been delivered by the federal government, Scott Morrison has again utterly failed in achieving his own target. Frontline healthcare workers, aged-care workers and disability residents—all in the government's 1a rollout—were all supposed to be vaccinated by Easter; yet so many of them are still to receive their jabs.

At 400,000 doses per week, it will take two years for everyone to be protected from the virus—two years! The Prime Minister has been saying for weeks now that the vaccination program was ramping up. Well, it had better ramp up a mighty steep ramp, because he has no record of delivering on anything that he says he will. It's heartbreaking for so many people in our economy who need our borders open and who are relying on the rollout of the vaccine for their businesses to survive. It is heartbreaking for people who fear another lockdown and the pressure that that puts on their livelihoods and on the economy. It is negligent.

We know that this virus is already mutating. There are variants spreading right through the world now that will probably require populations to receive a booster shot. But, in order to get the booster shot, we have to first be vaccinated. I grant you that, but countries like the UK are preparing for booster shots as early as September and October. I'm already being asked by doctors and other people in my electorate what the plan is for booster shots. Have we bought booster shots? Are we yet negotiating with companies to have them onshore, ready when they need to be given, or are we going to be left at the back of the queue again just as we were with the vaccines? I note, significantly, that it appears that there was no money allocated for boosters in the budget.

With regard to the vaccine rollout in aged care, it's been nothing short of a disaster. Families and residents have been constantly asking me when their residential aged-care facilities will receive the vaccine. I have had heartbreaking phone calls from people who have seen the state publicly run facility in a regional town get all their doses for the staff to be vaccinated and for the families to be happy and content that their residents are safe, while a privately run facility down the road that is in the purview of the federal government has no idea when the vaccines will be rolled out there. The public health networks are in the dark as much as we are. It's pretty crook when aged-care providers are ringing me and other local members to find out when their facilities will be getting their vaccinations. They can't find out that information from the federal government.

We are hearing stories of nursing homes being all set up, the residents all primed, the families all informed and the staff all ready to roll out the vaccinations, but no-one turns up. One aged-care facility told me recently that they went through the whole process. They lined everybody up—they had 160 residents—and everybody was getting a vaccination, until there were about eight residents left and they ran out. That facility had to tell those eight residents and their families that they had to miss out, with no plan to come back and no plan to make sure that those residents actually got the vaccination in the end. It was reported on the ABC that one aged-care facility, TLC—which actually have a facility in my electorate—decided to take the vaccination of their residents and their staff into their own hands. Their CEO, Lou Pascuzzi, said:

We really didn't want our residents, staff or contractors to endure another winter with the nervousness and trepidation that they have endured over the last 16 months.

We've got immunisation capabilities and primary care capabilities.

We decided to approach the government … and ask for permission to administer phase 1a ourselves.

That says a hell of a lot about the government's ability to roll out the vaccine to our aged-care facilities.

The other job the federal government had was to provide a safe national quarantine system, a responsibility that has been the Commonwealth's for more than a century. The hotel quarantine system that was put in place last year is not a long-term solution. What the Prime Minister needs to do is build a network of dedicated facilities around the country that are fit for purpose. This is a government which only acts when it has its back to the wall.

Even after all the horrors of the Royal Commission into Aged Care Quality and Safety, the Prime Minister still hasn't acknowledged that it was his cuts to the aged-care sector that have led to the crisis. The Prime Minister expects us to congratulate him for last night's budget announcements, but the truth is the package handed down last night still has huge gaps that leave our residents in aged care wanting. As someone who has spent a long time campaigning for aged care, I don't believe this budget package is the generational reform that the royal commission wanted and that the system so desperately needs. It seems to me to be more untied funding for providers that lacks proper wage increases for new nurses and carers. The Prime Minister must explain why he has refused to accept recommendations that require a registered nurse to be on duty at all times in nursing homes, why the government have refused to act to help increase the wages of nurses and carers, why they have failed to implement a registration program for carers and why the Prime Minister has not committed to implementing a comprehensive workforce plan.

Critically, there is no plan to ensure real accountability and transparency of taxpayers' money. There is nothing that seriously reforms the system to see exactly where the money goes, no change to the auditing requirements to stop money being funnelled away to Maseratis and offshore tax havens or secret family trusts, when residents are not being fed properly or are in soiled clothing and can't get access to proper care. As for the promises of staffing guarantees—two years down the track, mind you—and other promises made for aged care, given the huge gap between this Prime Minister's announcements and delivery, why should older Australians and their families trust him to follow through and fix his broken system?

On another point, I am a nurse, and I have been thinking a lot recently about preventive and primary health care, because that seems to be a term that this government rarely uses. There was practically nothing in the budget for preventive health care. As a nurse I was trained to consider the social determinants of health. That means your economic circumstances play a major role in your health outcomes and need to be dealt with if we are to have a healthy nation. Study after study shows that investing in primary health care and preventive health is far cheaper and more effective than waiting for people to end up in hospital, in our tertiary care system, which is resource intensive, overrun and very much more expensive. It is literally the old 'fence at the top of the cliff rather than the ambulance at the bottom of the cliff' argument. It is a no-brainer.

We need bolder thinking. We need healthcare reform. We need better and longer access to general practitioners, where there is a crisis of shortages. We need more access to nurse-practitioner led care, where appropriate, to improve reach and health outcomes. We need easier access to allied health practitioners, healthier kids with wraparound services attached to schools, more community led health care, with community health centres, and investment in Aboriginal health community care. We need so much more from a government when it comes to our nation's health. We need to bolster the health of the nation. And on this day, International Nurses Day, I would like to say a great big thankyou to all the nurses in Australia, who worked so hard to keep us safe during the COVID crisis and who work hard every day to keep the health of our nation in a better state.