Shadow Minister for Health and Human Services

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18
Jun

Brett Whiteley Budget Response 2008

2008

Today, I believe, has been a defining moment in the life of this Parliament, defining in the fact that it is all about ideas, vision and putting a sense of perspective into the next 10 years of this State's illustrious history.

Today the Liberal Leader, Will Hodgman, set about establishing further his and our credentials to be the alternative government in this State. The Premier heralds much his favourite saying that it is all about ideas. He is right, it is all about ideas, and today Will Hodgman set out his agenda - albeit briefly in the time allocated and with still 20 months to go to an election - of some of the important things that we as the alternative government believe should be a priority for you as the current Government.

Much was spoken about by the Leader - and I will not go into the details - about the accountability that the Tasmanian public is seeking from this place. There are many ways in which we can improve the accountability lines and structures in this place. Today Will Hodgman set out a plan that would include a number of initiatives that would give more transparency, I believe, to the Parliament of Tasmania. Not only that, the Leader of the Opposition today stamped his credentials well and truly beyond the credentials of new Premier Bartlett when it comes to an understanding and a practical outworking of the issue of climate change.

We have this new Premier who says often that he is in touch with the issues, that he is a new-generation, contemporary member of parliament, who is not nailed to the ideologies of the past but is a new and fresh premier. But what did we see in this Budget when it came to climate change - very little. What did we see from the alternative premier today? At the very least we saw a practical plan to work alongside ordinary Tasmanians to give them the opportunity to feel as though they can contribute to the reduction of greenhouse gases. That is what we have done today. Out in the suburbs that we all represent the people have been persuaded that there is an issue when it comes to global warming. They have been persuaded, albeit slowly and some still very sceptically, that we are indulgent users of energy in this State. Yet at the same time they struggle to embrace, I believe, the big-picture issues that many world leaders continue to talk about because they cannot relate to it and see it as something they can implement in their everyday lives. That is why we need to get to the backyards and homes of Tasmanian households and families to assist them in being a part of the solution and no longer being a part of the problem.

Today the alternative premier in this State, Will Hodgman, outlined some practical measures that will go alongside suburban Tasmania - for example, moving to solar hot water systems, making sure our homes have the insulation required to see reductions of 20 and 30 and 40 per cent in the average household energy consumption bill. That is why the alternative premier, Will Hodgman, outlined today that, as an alternative government, we would be making cash available, up to $1 000 in some cases and up to $500 in other cases, to make it a reality for ordinary Tasmanians to make the changes they want to make in their own backyards. That initiative alone, over a four-year period, would entitle up to 36 000 Tasmanians to make a shift to a more energy conserving environment in their own backyard. That should be applauded. That is an idea. It is all about ideas and we have put those ideas firmly on the table today.

Not only that, we have taken very seriously those matters that pertain to public transport. I highlight the one area that I think is really important. When it comes to public transport in this State we need to promote that option to our people. That is why today the Leader, Will Hodgman, has reaffirmed our commitment to ensuring that seniors in this State can access public transport in predetermined times - not necessarily in peak hours - to put them on Metro buses for free. Some people might ask what is all that about and what difference will that make. Believe it or not there are many seniors in this State who are still driving cars, finding the expenditure on fuel exorbitant and eating into their pensions and low incomes. We need to be serious about getting people off our roads. We need to be very serious about ensuring we create an example for others to follow. It is about ideas. What we saw today was an example of an alternative government that does have ideas.

A range of other ideas have been outlined by the Leader and reiterated by the Deputy Leader. I will not go any further into those because time will not allow. I have the responsibility for the biggest portfolio area of the Budget - Health and Human Services. I would now like to move my attention to that and to try to it justice.

The minister's own budget snapshot shows that we are now spending $1.4 billion on health and associated human services in this State. That is up from $711 million just a decade ago - so basically double. The key question, though, is whether we are achieving positive outcomes for Tasmanian from that $1 billion-plus spend. We would argue that we are not. Let us take hospitals, for example. The hospitals and ambulance budget has increased from $330 million to $692.2 million over the last 10 years. Yet, over that very same period, elective surgery waiting lists will have increased 50 per cent. That is a shame. The total anticipated waiting list will be at 8 950 by the end of 2008-09. Even worse than that, the minister is predicting elective surgery waiting lists to grow because of her Federal colleague's changes to the Medicare levy.

The Rudd super announcement of how he is going to fix up health in this State has in fact a prevailing impact on the State health budget of Tasmania. I understand today, in question time in Federal Parliament, that this very matter about the Tasmanian Budget was raised, indicating that the decision by Rudd to change the surcharge affecting certain members of the Australian public will in fact cause a huge increase in public hospital waiting lists across the country. My sources tell me that he was shocked. He was embarrassed and probably quite angry with his Tasmanian counterparts for, dare I say, lifting the lid on what is an obvious error in public policy. We believe that this will lead to 5 000 to 7 000 Tasmanians pulling out of private health insurance over the next six to 18 months and it will have a flow-on impact that we are yet to understand or feel the pain of. Once private health funds realise that they are seeing younger, healthier members of the Australian public pull out of private health insurance, that will have a knock-on effect in premiums. I predict that those private health cover premiums could explode over the next 12 months by 12-14 per cent. That will then have a flow-on impact and will see even more people pulling out of the private health system and finding themselves added to the ever-increasing waiting lists in the public hospital system. These changes have been publicly supported by Minister Giddings. She said on ABC Radio last week - and this is a quote - 'I don't think it will have a dramatic effect in Tasmania'. Well, I believe she is wrong; I believe time will prove that she is wrong. The footnotes in the Budget indicate that she was also misleading the Tasmanian public.

The question for the minister today is: what component of that 9 000 elective surgery waiting list will be a result of the changes made by the Rudd Government? What compensation package has she and her other State colleagues negotiated with the Federal Government to combat this increased pressure on our public hospital system?

Other performance indicators for our hospital system are also increasing. We have a health plan which will upgrade community health facilities and build new centres to take the pressure off our hospital emergency departments. We welcome that and see that as a positive initiative, but the Government predicts that presentations to emergency departments will still increase from 102 179 to 106 266 by the end of the 2008-09 budget year. Unplanned hospital admissions are expected to remain static at 3.4 per cent; this figure has more than tripled over the last decade. Ambulance funding has not been placed on a sustainable basis. Stop-gap funding of $5 million will be welcomed by the sector in this Budget, while - and I quote from the Budget - 'work continues on developing a sustainable funding strategy'. The Treasurer, to be quite frank, has bungled his first two insipid attempts at trying to introduce an equitable ambulance levy. I do not believe there is such a thing as an equitable ambulance levy. We do not support an ambulance levy of any stature or any nature. We believe that government has a core responsibility to provide such services at a sustainable level.

There is money in the Budget for new ambulances and ambulance station upgrades. They are needed and welcomed and we thank the Government for that today. However, there is no point in vehicles and buildings without the staff to drive them or work in them. It makes no sense. It looks good on a glossy brochure; it looks and sounds great on a 15-second sound grab on the news, but there is no point. We need the staff to put in them. We need to be reducing the stress on staff who currently work in the ambulance sector. We know from the Government's performance information that ambulance call-outs are expected to increase to nearly 65 000 people by the end of this budget year. That will continue to put enormous stress and pressure on ambulance workers.

While we are being critical of the Budget, why cannot the budget papers publish information about individual hospital funding? What is the budget this year for the Launceston General Hospital? After all it has been through in the past year, what is the budget? What is the budget for the North West Regional Hospital? What is the budget for the Royal Hobart Hospital? How can we be assured that funding to hospitals is being distributed on a regional and equitable basis based on population, presentations, demographics and case mix. We cannot know, but we should know and we should, as the Liberals have heralded for some time now, be moving towards a far more local regional management system of health under a statewide plan.

I turn now, Mr Speaker, to preventive health in this State. Again, despite doubling the Health budget, health indicators have gone backwards considerably over the last 10 years. According to Dr Roscoe Taylor, the Director of Public Health, in the State of Public Health Report delivered just recently, Tasmania as a whole tends to have a poorer health status than most other jurisdictions. According to that report, there is a significant gap in life expectancy between Tasmania and Australia. Tasmania has the second-lowest life expectancy of all States and Territories, after only the Northern Territory. Avoidable mortality is 192 deaths per 100 000 population, compared to 176.6 for the rest of the country. Tasmania has the highest rate of current smokers of all States and Territories and the proportion of excessive alcohol consumption has increased in Tasmania, while it has declined across the rest of the country. A total of 48.9 per cent of Tasmania's population is overweight or obese, up from 36.5 per cent in 1989-90. The Tasmanian death rate for diabetes was 29.1 per 100 000, significantly higher - nearly double, in fact - than the rest of Australia's rate of 16.1 per 100 000. The occurrence of diabetes in this State is a national disgrace and is in fact a health crisis before our very eyes. So what value is Tasmania getting from $1.4 billion of Health funding? A bigger question is whether we are targeting our health dollars sufficiently to get the best value for the health spend.

A 2008 TasCOSS forum on a health promotion foundation model heard recently that Tasmania had an uncoordinated approach to health promotion, that health promotion messages alone do not work, and that practical and evidence-based approaches can deliver far more positive outcomes. The forum also heard that TasCOSS undertook consultations as to how low-income earners - who can barely afford food, shelter, phone, transport and medicine - can improve their health. The answer was, believe it or not, practical programs that provided simple yet essential assistance; support and incentives to assist these people in making lifestyle changes that will have a long-lasting, positive impact on their health outcomes. This could mean anything from coordinating local walking groups to helping make good food for less money, or subsidies for children to participate in sport. They are simple and basic, but it is about ideas.

We know that social determinants are a key factor in poor health outcomes, but while health promotion remains within the Department of Health and Human Services, there will always be competing interests for the health dollar. That is why the State Liberals, as the alternative government, will establish an independent health promotion foundation on a model based on the successful Victorian and Western Australian operations, which provides evidence-based approaches to health promotion, practical assistance and programs of support, incentives to the community, advice to government, and draws and coordinates all health promotion in Tasmania together. It will be funded not just by the public sector, but will encourage investment in long-term health outcomes by the private sector. Its aim will be to reduce health inequalities from social, economic and geographical influences.

This Tasmanian health promotion foundation will receive funding of $5 million per year by the end of the 2014 first term of a Hodgman Liberal government. We will accept corporate and private sector philanthropic contributions, and we will pursue at every opportunity Federal funding by way of grants.

Again, as Dr Taylor states in his public health report, there is ample room for improvement in preventive and public health in Tasmania., but instead of improving the health of all Tasmanians, this Budget provides a public sector health and wellbeing program. Of course the devil will be in the detail of this and how well it will work, if it works at all, but we would prefer to see a health and wellbeing program that looks after all Tasmanians and not just public servants, particularly as the Treasurer's own demographic advisory report shows clearly that 33 000 Tasmanians of working age are not participating in the work force because of ill health. How can we get these people in to work?

I do not think it makes any sense whatsoever for a government to suddenly find $3.3 million to spend on its own work force, and it could be argued very strongly that most of those people in that work force have the ways and the means, by their jobs, to afford to undertake the very thing that this Government purports they will help them to do regarding health advice and so on. Why are we not expending that much-needed $3.3 million helping to find ways to assist the more vulnerable and those from lower-income areas in the community? I find it extraordinary that the Government can find that money for its own work force, and yet cannot find a similar amount of money for those not in a position to afford some of the most basic health care advice.

So while the Government is now talking about preventive health, there does not seem to be any real urgency, in my view, from the current budget paper. There are integrated care centres at Launceston and a Clarence GP super-clinic, but on the latter I must say that the Clarence Community Health Centre is continually understaffed and our offices have had many complaints about the difficulties people have had in getting timely appointments, with many of them ending up in hospital emergency departments. We raised this very matter in Estimates last year and the minister blamed the Howard Government for the shortage of GPs. Well, with the new Federal Labor Government the situation has not improved and does not appear that it will improve, and a recent letter to our Leader, Will Hodgman, shows that the centre is operating at two-thirds of its capacity, and the minister now blames international work force shortages of GPs instead of the Federal Government. I wonder what excuse will be next.

Minister Giddings also says she has written to her mates in Canberra requesting that this area be identified as an area of need, but her applications to her Labor colleagues, I believe, have been denied. How will this centre become a GP super-clinic if we cannot get the extra GPs into the area? This Budget earmarks $18 million. It is unclear and we need to know if that money is for an upgraded building, for infrastructure only - and if there will be extra staff and extra doctors, when will they be in operation?

We also need to know when the integrated care centre at Launceston will be up and running to take the pressure off the huge number of emergency presentations at the Launceston General Hospital. When we recently visited the hospital, there was a full emergency department, and well into the afternoon staff were tearing their hair out trying to find beds for people who had turned up overnight needing them. We welcome the $12 million in the Budget for the improvements and the rebuild of the emergency department at the Launceston General Hospital, and the capital development of the hospital coupled with the integrated health care centre, which we believe should be a 24-7 centre. It could not come soon enough, as far as I am concerned, so I will be keen to see the minister stick to the time frames that she has indicated on this matter.

Mr Deputy Speaker, according to the Government's own budget documents, oral health funding has increased from $9.3 million 10 years ago to $22.7 million, and yet again we see there are 40 000 fewer dental visits for children each year. So instead of $9.3 million 10 years ago, we have expended $22.7 million this year, and yet there are 40 000 fewer dental visits for children each year and waiting lists for adults for services and dentures are expected to reach almost 10 000 people. That is a disgrace. No minister of the Crown should be prepared to defend that, and any minister of the Crown with any degree of respect for our fellow Tasmanians would ensure that that matter was beaten into submission, because it is completely out of control - 10 000 adults waiting for services and dentures. Again, that is an area where a big spend has not meant good positive outcomes. Even worse, I note in the performance indicators that episodic visits will reach 26 000 by the end of this year, while general dental visits will only be 7 300. Episodic visits, as most of you would be aware, are emergency dental care. We are spending more at the acute level of dentistry than we are on the preventive side. When will this Government get the message about preventive health care measures? Future Liberal policy, which we will announce at a later stage, will be definitely and obviously aimed at creating a better balance in this area.

We welcome in the Budget the extra funding for alcohol and drug services, but again we see no improvement anticipated in performance outcomes as a result of higher spending. I find that quite extraordinary. Also, there are capacity constraints such as work force recruitment and retention, suitable training and existing service infrastructure which will prevent the effective delivery of this extra funding into the sector. We hope that the minister will be informed by the sector about how best to utilise this money for maximum outcomes and for the future. It is indeed unfortunate that the long-awaited review into the alcohol and drug sector was disappointingly short of detail and failed to articulate a clear way forward.

The performance indicators for mental health services, the few contained in the budget papers, are also disappointing, particularly that active clients in community and residential facilities are expected to fall by 1 000 by the end of this year. With Tasmania having a greater prevalence of mental health problems according to the State of our Public Health report - with one in nine reporting a long-term mental or behavioural problem as against one in 10, a difference of 10 per cent - I fail to see how the number of active clients in community mental health services could be predicted to fall by 1 000. There may be an explanation for that, but I doubt it. We also remain concerned at the level of access to child and adolescent mental health services in this State and the need for more timely intervention to assist families and children before it is too late.

We support reforms that are currently being undertaken in Child and Family Services, particularly better family support programs and therapeutic services for children in out-of-home care. This was a key plank of the Liberals' 2006 election platform and we congratulate the Government today for adopting what we believe is a very positive measure. We speak, as all members in the Parliament do, to families and advocates every day about these issues. We share their frustrations at the level of support for families, or the lack of it, particularly of teenagers who are experiencing behavioural difficulties. Again, we go back to the value of money being provided by this Government in terms of service delivery. Funding has doubled for Child and Family Services over the past decade but notifications have increased from just over 1 000 in 1998 to a massive 14 000 in 2008, with a worrying resubstantiation rate of 29 per cent expected in 2008-09. This clearly shows that extra money being spent by this Government is not preventing nor protecting children from abuse in this State.

Probably the poorest outcomes we have seen are in relation to affordable housing. Funding has increased from $77 million in 1998 to $141 million in 2008 but waiting lists are higher than they were 10 years ago and are expected to grow again this year. The number of public housing applicants being housed each year has decreased from 2 700 in 1998 to just 1 000 expected to be housed in 2008. Further, the former Premier's 'immediate $60 million injection for public housing' has now become, under the new Premier, $60 million over four years with very little being spent this year. This is disappointing. This has been misleading and is not acceptable. Building or buying just 50 kit homes this year, when there are 2 700 Tasmanian on waiting lists, is not clever or kind. I believe it to be indifferent and cruel.

(the following contribution was made on the adjournment)

Tasmanians will recall the 2005 report completed by the Auditor-General into public housing in this State. That was three years ago and since then things have only got worse as far as housing options in this State are concerned. The Auditor-General provided the Government with a number of recommendations in his 2005 report, yet nearly four years later only 70 per cent of those recommendations have been completed. This year's Budget also notes that further consultation will take place in relation to Housing Tasmania becoming a government business enterprise. As the minister fully knows, the corporatisation of housing bodies elsewhere in the world has seen massive rent rises for public housing tenants, increased asset sales and inadequate capacity to fund property replacement and maintenance upgrades.

The minister herself rejected the idea that Housing Tasmania would become a GBE as recently as last year. What has changed, Minister? Why are you now considering housing as a GBE when firmly rejecting the idea last year when you were asked the question? Winter is upon us and yet people in Tasmania are still living in cars, tents and on the streets. Crisis shelters are turning people away, there are thousands of Tasmanians on waiting lists and this Budget will not change a thing.

Today, after a year-long wait, we have seen the KPMG report into disability services and the Government's response to that review. The Liberals have today welcomed the plan, as it largely follows our own policies released just last month and foreshadowed in March during the state of the State address. There is general bipartisan support for reform of the disability services sector. Such reform is timely and one could say a little overdue. Labor has been in government a decade in this State and we have had many reports and reviews into this sector over that period. We now have a review with a promise of implementation and that alone has to be a step in the right direction. I do have some initial concerns about the plan in that it will only assist around 1 000 more clients by 2010-11. We have half that many already on the waiting list and we know from the KPMG report that the demand for disability services is growing, not to mention the large number of Tasmanians who cannot get onto the waiting list now.

I am also concerned that the model being adopted by the Government appears to be a top-down approach rather than a people-focused program like the UK models that are operating to an extent in Western Australia and Queensland. However, I do give credit where it is due and I have asked for a briefing at the earliest opportunity and Alison Jacob has said that she will accommodate that. Certainly without a doubt, we do need reform in this area and those with disabilities and their families will be heartened to see government attention directed at their needs. As with any new public policy direction, the devil is always in the detail and the implementation, and as that process is over a three-year period, we will try to be as patient as possible, but I do warn the minister respectfully that bureaucratic reform processes should not take the place of getting services to the people in the interim. Tasmanians who have already been waiting too long do not need to be told that they will have to wait another three years before they can get some level of support from this Government.

I also raise the need for this Government to assist the non-government sector in delivering quality services to people with disabilities, and this means help in attracting, recruiting, training and retaining quality staff. Without that support this model will fall over before it even starts. Going back, however, to the Budget and performance indicators, it is concerning that these indicators are again going backwards, with only 1 104 clients expected to be in supported accommodation at the end of 2009, as opposed to 1 100 in 2005-06, while only 1 487 people are expected to receive day services as opposed to 1 592 in 2005-06. Waiting lists for supported accommodation and day options are expected to increase by the end of the 2008-09 budget period. So there is no short-term or even medium-term relief in disability services as a result of the reforms released today.

As I said at the start of my speech, it is a defining moment today in that it is a battle of ideas. The State Liberal Opposition, as the alternative government represented today in the Parliament by a comprehensive speech by the Leader of the Opposition, has put its credibility on the line and we will continue to roll out policies that benefit the people of Tasmania.