PUBLIC HOSPITAL SERVICES (CONTROL OF PRIVATISATION) BILL
Debate resumed from 29th October.
(Ku-ring-gai) [10.53]: During the previous session of this Parliament I was saying that two issues are involved in the bill introduced by the honourable member for South Coast. I will touch briefly on both issues this morning. Those issues are: the management of public hospital services for the benefit of the people and the management of the Government of New South Wales, whether it be by Executive Government or by the Parliament. As a broadcast journalist I, like many people in the community, was initially concerned about the privatisation debate. That is a reasonable concern. When this bill was first introduced - it must be at least 18 months ago now - my initial reaction was a knee jerk one, perhaps even an ideological one, based on the assumption that governments have to
own large facilities and, in this case, that governments have to own big hospitals. But when we open our minds to the realities of Australian economics and the responsibilities of providing the services that we need to provide, we see that it is not important to own big public hospital buildings - the provision of services is important. That is at the heart of the debate today.
The honourable member for South Coast, like members of the Australian Labor Party opposite, seems to believe that the business of government is to own big buildings; that there is something wrong with us if we give up that right or depart from that standard practice. But if we open our minds to Australia's economic realities we see that that is an anvil hanging around the neck of progress, preventing our efforts to provide health care services for the people of New South Wales. We are here to do the latter. We are bound to provide health care services for the people of New South Wales. We are doing that in the Port Macquarie model in a new way that will allow us to spend public money wisely and with good effect. In this case we will buy the provision of services for the people of Port Macquarie and elsewhere in New South Wales - the most efficient and effective use of public money.
The private sector will provide the infrastructure and we will provide the services for the people of Port Macquarie. We could not have a more equitable and sensible arrangement than that. I urge the honourable member for South Coast to reconsider this bill. I urge honourable members opposite to open their minds to reality. The Leader of the Opposition has spoken about this on many occasions. He knows the reality. Honourable members opposite know that, apart from some ideological or political gain that they would be able to make by arguing that the Government is selling off the farm, the Port Macquarie model is the best way to provide health care services for the people of New South Wales.
The Leader of the Opposition, in the run-up to the last State election in 1990, said: "In the 1990s State governments alone will not be able to provide the new infrastructure required. The private sector will become increasingly involved in providing this infrastructure". I agree with the Leader of the Opposition. He is right. Honourable members opposite know he is right. Perhaps the honourable member for South Coast alone is not convinced. I urge him to open his mind to the fact that the Government provides health care services, not buildings.
If the Government were not living up to its responsibility to provide health care services, to construct a certain number of buildings and provide a certain amount of infrastructure, the debate would be different. But the Government is providing $1.4 billion for publicly funded projects in the health care system alone. There is no more money available, so what are the options? The honourable member for South Coast in effect is saying to the people of Port Macquarie: "That is tough. Just wait. If you want a new hospital, if you want your children to attend that hospital, or if you need knee replacement surgery, you will have to line up. You will just have to wait because the Government has to pay for the new hospital buildings".
Does the honourable member for South Coast have the mandate to say that to the people of Port Macquarie? Does he have the mandate to say that to the people of Ku-ring-gai who depend on the Hornsby-Ku-ring-gai Hospital, which has been an excellent community facility for decades? Does he have the right or the mandate to say that to the people of New South Wales? He does not. He is here to represent the people of South Coast. That involves being able to look after their interests, meet their needs, liaise with government departments, talk with the Government on their behalf and represent them in the Parliament. That mandate does not enable him to say to the rest of the people of New South Wales, and in this case the people of Port Macquarie: "Tough. I have an ideological objection to you getting a hospital now rather than later". I think we have to do better than that.
As I said earlier, I urge the honourable member for South Coast to open his mind to economic reality. The Government is about providing health care services, but in a different way. There are plenty of safeguards in the system. The honourable member for South Coast would be well aware that the Minister for Health wrote recently to the honourable member for Manly. The Minister has negotiated with the honourable member for Manly and has come up with a package of measures that will enable proper safeguards and enable scrutiny by the Parliament, where it is appropriate. More important, the package will enable the people of Port Macquarie and elsewhere in New South Wales to get health care services.
Five hospitals, a small proportion of the 255 public hospitals throughout the State, will be affected by these proposals, which are concerned not with privatisation but with the private provision of infrastructure for government provision of health care services. Any so-called privatisation of a public hospital will be subject to evaluation and reporting to Parliament, something that is important to the honourable member for South Coast. The Minister will reconsider the plan for private operators to manage community health services. That will be a matter for open discussion. The Minister will consider legislation allowing confidential scrutiny by the Public Accounts Committee of any contract that is referred to the Parliament for future proposals. Those are four sensible ways to deal with the problem that some people have raised in the debate about this so-called privatisation of hospitals. The bill will limit to 25 per cent the use of available beds in private hospitals by public patients. We have to ask: Why? What possible reason is there to limit them? Though there are free beds in private hospitals and people lining up to get into public hospital facilities - free beds on the one hand and people who need them on the other - the bill will allow only a quarter of the available beds to be used. There is no reason for it.
Another impact of the bill would result in Parliament becoming the manager of health care in this State. This brings me to the second matter that I mentioned at the outset; it comes to the heart of who is managing New South Wales, it comes to the heart of the Westminster system. Honourable members
opposite should go back and read the texts, read the history books and find how the Westminster system works. Executive government has the role, the mandate, the responsibility, to manage the State. It gets that responsibility by mandate of the people who elected it. This does not mean that an individual member - in this case the honourable member for South Coast - can stand in the way of a government initiative which seeks to provide health care services in the most appropriate manner. This bill would do that. It would reverse the whole onus of the Westminster system. The bill wants to make Parliament the body that manages the hospital system. Everything would have to come back to Parliament. There would need to be management committee meetings all the time just to keep the hospital system running, to make sure that people in my electorate, and in the electorate of the honourable member for South Coast and right across New South Wales, would have the benefit of health care services.
Your mob closed one down.
I will repeat this for the benefit of the honourable member for Kiama: our mob is spending $1.4 billion in government funded projects at the moment. The Executive Government has to set the course and has to decide the policy, because it has the responsibility to do so. I am concerned at the tone of this debate and of many debates at the moment about the place of the Parliament in managing New South Wales. Ours should be a strong independent Parliament where members can air the concerns of the people of New South Wales and where the Executive Government is fully accountable. That is the guts of the whole Westminster system. But we should not turn it on its head and have every government measure overturned or scrutinised for political- ideological reason alone. That is what this bill does and the same agenda forms part of the debate on many other bills.
I urge members opposite to open their minds to the new way of providing health care services. That is what we are here to do, not to prop up old ideological shibboleths, not to hold true to old ways of thinking that no longer work for the provision of health care services for the people of New South Wales. We must ensure that one member alone cannot stand in the way of that provision of health care services for at the end of the day it is not the honourable member for South Coast who will be held accountable for whether health care services are provided for New South Wales; he will not be judged. That is not the way the system works. The Executive Government will be held accountable for it has that responsibility. The honourable member for South Coast should withdraw his bill. I urge members opposite to vote against the bill and to allow the Executive Government to get on with what it is doing well - taking responsibility for the health care needs of the people of New South Wales. I will vote against the bill and I urge every other member to do likewise.
(Liverpool) [11.5]: I am not leading for the Opposition in this matter. The honourable member for Ku-ring-gai, for whom I had the greatest respect as a radio journalist - but not presently as a parliamentarian - shows his impertinence by his statements in this House. His constituents have choices in health care, particularly hospital services: mine do not. For him to say that the honourable member for South Coast is impertinent in bringing forward this bill is to forget what the Westminster parliamentary system is about. The honourable member for South Coast alone cannot get this bill passed; it requires the majority of the Parliament. I reject the definition of the Westminster system put by the honourable member for Ku-ring-gai. It is staggering. I have a mandate from my constituents in Liverpool, with the exception of one who is going backwards on the issue fairly quickly, to oppose the privatisation of Liverpool hospital. Let us not dilly-dally on what it is about.
The Minister is in the chair; let him get up when he speaks, if he is speaking, and deny that the third schedule has gone. We are not talking about that any more, we are not talking about some of the other concepts; we are talking about a proposal for a fully privatised hospital at Liverpool. Why has the Minister gagged the South Western Sydney Area Health Service? Everybody else can go out and talk to the people of Liverpool. The representatives of St Vincent's - I am not talking about the Sisters of Charity, I am talking about the board - and everybody else can have their say, but there has been a gag on the board ever since the proposal arose. Why? Because, from the beginning, the arguments have been valid and cannot be overcome by any of the proponents of this scheme. I am delighted to support the legislation of the honourable member for South Coast because it is clearly specified in the objects of the bill that one of the hospitals involved is Liverpool hospital.
You disagree with your leader, do you?
I do not disagree with my leader. There has been always a role to be played by the private sector in the delivery of health care in this country and in this State, but it is not the role the honourable member for Ku-ring-gai proposes it should play now. It is not the Executive Government that makes or breaks matters affecting the people of this State; it is this Parliament, the highest court in the land, the controller of the Executive Government. I have had an opportunity that the honourable member for Ku-ring-gai has not had and is not likely to have. I have sat on the front bench and have been a Minister. I know exactly what forms the role of the Parliament. The Parliament is supreme. And today or on some future occasion the Parliament will make a decision on this bill which will have a very clear effect on the people of my electorate.
It will stifle their ability to obtain health care.
Their ability to obtain health care is affected by the decisions of the Government. In 1987, as Minister for Health, I determined that Liverpool Hospital was to be the next teaching hospital and that project was to be commenced on the completion of the John Hunter teaching hospital which was then under construction in Newcastle. The Liverpool project now has been slowed down.
That is a lie.
It is not a lie. It could have been built faster but was slowed down by the Minister. The House has heard of the Minister's commitment to southwestern Sydney but if Liverpool Hospital is privatised, the very special networking that has been created since the wonderful professorial appointments there, and the commitment to the board to link hospitals such as Bankstown, Fairfield, Campbelltown and Camden and others into a totally unique scheme for the provision of health services in the most under resourced health area in the State, will be lost. The network cannot be run in that way with the teaching hospital privatised. I have nothing against St Vincent's. I have been an in patient and a casualty patient at St Vincent's. It is a wonderful institution, and I saw that at first hand as Minister for Health. I do not in any way criticise it. But what does St Vincent's bring to Liverpool? St Vincent's is the national heart transplant unit and will remain so. It is not expected that heart transplants will be performed in Liverpool. St Vincent's is a major provider of AIDS-related services. Southwestern Sydney has one of the lowest HIV rates in the State.
The current problems of people from south western Sydney having to travel out of the area for the provision of tertiary level services will continue. I spent half of my life in the eastern suburbs and have spent the other half, 22 years, in western Sydney. I know about the fights that the member opposite and his ilk fought to stop Westmead hospital being built. Over time all the dire things have not happened. But Westmead was never to be the sole provider of tertiary level health services in western Sydney. It is absolutely crucial that Liverpool Hospital be a public hospital, as it was always intended to be and as it should be. One can only ask why it is that after several months I get an answer of four or five lines to a 20-part question about the proposed takeover. Why is it that the Minister will not make public after so much time the financial details of the proposal? Is it the Sisters of Charity who will borrow the $200 million? No, it is not. The Minister shrugs his shoulders. He knows full well that it is not. Who is it? Where are they borrowing the money from and through which institution? At what rate are they borrowing it and how will it be repaid? Again he shrugs his shoulders.
If I knew I would tell the honourable member.
The Minister was given the brief by his mates in the Cabinet and had to wear it. It started when he was the Minister for Health Services and his colleague in the other place was the Minister for Health. The Minister will not answer my 20-part question and certainly would not answer the 37-part question asked by the member for South Coast. Why? They are simple questions, questions to which the people of Liverpool are entitled to have answers. They are questions that the Parliament is entitled to have answered. But the Minister will not answer them. Is it any wonder the people of Liverpool are opposed to this proposal? I want to see the honourable member for Badgerys Creek and the honourable member for Camden support the Government's Opposition to this bill and say that they support the privatisation of Liverpool Hospital. That will not happen. Where are they? They know that it is not just the board, not just the medical staff council, who are opposed to this; there is unanimous opposition from the staff at the hospital. But, leaving all of that to one side, for I am not particularly influenced by it, there remains the overwhelming opposition of the people of Liverpool, Moorebank, Badgerys Creek, Fairfield, Smithfield, Bankstown and all the electorates that will be served by this tertiary institution, which it is claimed will bring to southwestern Sydney a level of service of which they have dreamed but to which the have been entitled for some time.
I know that everything cannot be built at once, but this was entitled to be the next major project after the completion of the John Hunter Hospital. The people are entitled to have it built, as it was always believed it would be built. If people want private hospital services in the Liverpool area they can go with great confidence to the Idaho Private Hospital or the Dick Street Private Hospital, both of which have been providing medical services for private patients for many years, and doing it well. It is all very well for the honourable member for Ku-ring-gai and other members on that side of the House who have substantial rates of medical insurance in their electorates. Southwestern Sydney - and Liverpool in particular - does not. Those areas have among the lowest rates of private medical insurance. People want public hospital resources.
Liverpool Hospital is not some ordinary district hospital. It is going to be the second tertiary level hospital in the whole of greater western Sydney. Its importance to the people of Liverpool cannot be overstated. One only has to look at all the epidemiological evidence, acknowledged by the Minister and by everyone, their rates of cardiac disease, the problems they have in the field of oncology, the morbidity rates, to gain support for that. No one argues that the needs exist, but the Minister wants to turn the whole thing on its head. We now have a rapidly developing network of hospitals providing a broader range of services but the Minister wants to change that by privatising the very hub of that service. It is being done by stealth. The Minister will not answer the questions that are properly being asked by all with an interest in the matter. Why does the Minister think the people do not believe him? If the Government beats the bill, it will not beat the people. This is not a political issue in the community.
That is rubbish.
It is not political.
The honourable member is making it a political issue.
I am not making it a political issue; members opposite are. Again we have great impertinence from the honourable member for Ku-ring-gai. People are knocking my door down opposing this proposal. I would love to know the last time those people voted Labor, or more particularly the next time they will do so, because it will be the first time.
They will not be voting Labor on 13th March.
Of course they will. Who would vote for a prospective coalition government with Sinclair as the Deputy Prime Minister? Members opposite do not understand. They take things for granted. I grew up in the eastern suburbs where, if one was crook, there was a choice. One had to work out which hospital to attend. The people of western Sydney do not have those choices. It is not a question of whether they will go to Liverpool or, if that hospital does not provide the particular service required, to one down the road. They cannot choose whether they should go to Prince of Wales, Prince Henry, St Vincent's, Prince Alfred, Royal North Shore or St George. These are all teaching hospitals within 10 or 15 minutes of one another. People in the west do not have the choice. They can go to Westmead hospital, which is overutilised because people think it is supposed to provide all of the resources. It should not, it was never intended to, and it cannot. That is why Liverpool Hospital is absolutely critical. [Extension of time agreed to
I have tried to make honourable members understand that this is an emotional issue in Liverpool. People in the electorate have good reason for that emotion. The Minister asks why I become cynical and angry about this issue. I placed a question upon notice about nursing positions at Liverpool Hospital. I got the answer: too much time involved. How is it that one of my colleagues can ask a question about Fairfield and receive the answer? I put another question on notice asking about the proposals each financial year for capital expenditure on redevelopment. The answer: it is not normal to do this; I have not done it; I cannot work it out. My colleague the honourable member for Penrith got the answer in regard to Nepean Hospital. That is why I have put another question upon notice asking why.
Government members wonder why we on this side of the House are a little cynical about all of this, when the Minister will not release the details. If he is so confident, why not tell us? We do not want to know the nitty-gritty commercial stuff. We just want to know what it is going to be. Will the Minister tell us that it is not going to be a totally privatised hospital? These task forces, working parties and groups have been going on for ages. We want to know exactly what is going to happen. We believe we already know. That is why this legislation is important to my constituents and to the constituents of other members. I have tried to use the forms of this House, by way of making speeches and asking questions, to find the answers to very reasonable questions, but without success. It seems that the only way to protect the people that I and others represent is by having legislation such as this proposed by the honourable member for South Coast that will enable the Parliament - the highest court in the land, the overseer of Executive Government - to test matters.
That is true.
Of course it is true. The honourable member used to say that to me when he was interviewing me: now, Minister, you are responsible to the Parliament.
The honourable member is not saying that today.
The honourable member used to duck and weave too.
No, I went straight up the middle. I also disagree with the proposition that a member represents only his or her electorate. I do not accept that. Honourable members are also here to be part of the Parliament that determines what is best for the whole State. The Government has a philosophical position on privatisation of hospitals; I have an entirely different position. One night at a function I sat next to a senior cardiac specialist who mentioned he worked at the Mayo Clinic. I said, "What do they do at the Mayo Clinic that they do not do at your teaching hospital in Sydney?" He said, "Nothing". I said, "So there is no difference?". He said, "Oh yes, there is a big difference. If you need a bypass in the United States you have to either have private insurance or it will cost you $45,000". If a patient needs a bypass in New South Wales, that patient gets it. The day we in this State or this nation move away from the basic principle that the provision of health care should be on the basis of medical need and not one's capacity to pay is the day we all ought to give it away - and that is exactly what this is about.
Honourable members opposite cannot tell me that without privatisation Liverpool Hospital will not be built. They are locked into building it. The Government is trying to take out the big lump of $200 million and use it for other projects. I am against that because my electorate has waited its turn, and its turn has well and truly arrived. The opportunity provided, as the buildings are completed, to have angiography and other facilities is too good to miss. Articles are appearing in the local newspaper describing Liverpool Hospital professorial appointments as not only good in New South Wales but nationally and internationally. Will those professors be run over by the St Vincent's medical staff council and people will still travel there? I am not prepared to cop it. I think it is bad. I have been inundated by community groups and organisations who are totally opposed to the privatisation. These are not Labor people but people across the total political spectrum. The issue of Liverpool Hospital is the most important issue to my constituents now and in the immediate future. It is the key issue with which they are concerned; they want, need and deserve a public hospital.
And everyone else just has to wait?
The honourable member for Ku-ring-gai stuns me. He has his seat over on the North Shore and tells us in the west that we have to wait. He would not know what hit him if he came out to southwestern Sydney. Like the rest of his mob, he takes for granted things that we wait years for - and we know we have to wait. Yet, we see it taken away and put somewhere else. The Government taxes us to death. The North Shore has mental health crisis teams and extended hours, but we do not; the North Shore has provision for developmentally disabled people, but we do not; the things children in North Shore schools take for granted we cannot. The honourable member for Ku-ring-gai should not sit there and talk about the need for the people of Liverpool or anywhere in western Sydney to have to wait: we have waited. We knew we had to wait our turn. Our turn has arrived in Liverpool.
Mr ACTING-SPEAKER (Mr Hazzard):
Order! The honourable member for Ku-ring-gai and the honourable member for Gordon will cease interjecting.
How dare those two members sit there and tell us we have to wait. We have waited. The honourable member for Gordon did not have to wait.
Order! I call the honourable member for Gordon to order.
I was told by a doctor at the local district hospital, "If your child gets ill tonight again, don't bother stopping here, take him to Camperdown" - 70 kilometres away. A pregnant woman in the inner city or on the North Shore has options when having a baby, but not those women in western Sydney. I would like to see the honourable member drive his pregnant wife 70 kilometres to admit her to a teaching hospital when she is in labour. Members opposite should not dare tell me about waiting. We have waited. We knew we had to wait. That is the way the world works. Our turn has arrived. The Government took the Royal Hospital for Women at Paddington and put it at Prince of Wales although King George V Hospital was a few minutes away. Liverpool is given something half the value and the great announcement of a new name. Logic should have determined that the Royal Hospital for Women at Paddington would go to Liverpool but that was not done. The Government fought the establishment of Westmead Hospital and with its attitude to this bill is trying to dud us on Liverpool Hospital. [Time expired
(Bathurst) [11.25]: We are fortunate in this Parliament to have a man who well understands the health system of New South Wales, the honourable member for Liverpool. He has highlighted the complete hypocrisy of the Government on this matter. I listened to the honourable member for Ku-ring-gai saying that we must change our system and revise our ideas, which means we must take the American system. Has the honourable member had experience with the American system? I will bet that he has never in an American hospital or experienced what Americans have to put up with. I have been a patient in an American hospital and I know exactly what the situation is.
Order! I call the Minister for Health to order.
I shall inform the House what happened to me in 1991 while in Los Angeles. I hurt my ankle and wanted to see a general practitioner to have the ankle examined. I was referred to a public hospital down the road. I attended that public hospital in the belief that the American health system was similar to ours. What a mistake that was! An X-ray was taken and I was given some pain killing tablets. An elastic band was put around my ankle. I was handed a bill for A$600 for that procedure. Had that procedure happened in this State and had I attended the private X-ray operator in Bathurst I could have claimed it through my medical fund and would have received the majority back. Government members should not tell us we must change our points of view about the type of health care being delivered to the people of Australia. The Federal Liberal leader today is advocating the dismantling of Medicare so that only a few poor people at the very bottom of the scale will receive any form of assistance. Members opposite should not tell me that we have to change our system. We do not have to become Americanised or privatise our public hospital system - a system under which the people providing the services make enormous profits at public expense and those needing hospital care cannot get it and die.
There are two public hospitals in Bathurst, the Bathurst Base Hospital and the Bathurst St Vincent's Hospital. One might ask how Bathurst came to have two public hospitals. I shall explain. In the days of the Askin Government the then Bishop of Bathurst, the Reverend Thomas, did a deal with the then member for Bathurst, Mr Clive Osborne, to set up St Vincent's Hospital as a public hospital in order to get the church off the hook with regard to operational costs of the hospital. When Labor was returned to office following an election in 1981, when I defeated Mr Osborne for the seat of Bathurst, there were two competing public hospitals in the same city paid for out of the public purse. What excellent management that was! To his credit Laurie Brereton bit the bullet and decided to curtail the activities of Bathurst St Vincent's Hospital. The church has not forgiven us and never will. I do not trust the members and management at St Vincent's Hospital. I have little faith in the integrity of the church to tell the truth with regard to this matter.
Recently I asked the Minister whether he was aware of a proposal by the Catholic Diocese of Bathurst to relinquish 12 of the 42 public beds then available at St Vincent's Hospital. The Minister replied, "Negotiations have been conducted over the past 18 months regarding the inclusion of some level of private hospital accommodation within St Vincent's Hospital, Bathurst" That is not the question, and that is not the answer he should have given. During the past 18 months negotiations have taken place for the inclusion of some public beds in a private hospital - St Vincent's Hospital at Bathurst.
The Minister is begging the question. In addition to that answer he says, "Any decision in this regard will depend on the final arrangements negotiated with St Vincent's Hospital, Bathurst". If we allow the system to get away with this, what will happen at Bathurst? Why is this being introduced? Because a cartel of doctors who cannot make enough money servicing Bathurst Base Hospital now want to open a private hospital at St Vincent's, but they want a certain number of public beds there. Health Care of Australia, the Minister's mates, bought into this arrangement but before they would touch it they wanted a certain number of public beds to make sure a profit was made. After a great deal of opposition, Health Care of Australia pulled out when they realised they could not win.
Who bobbed up next? The Catholic Church. The diocese of Bathurst decided it wanted to be involved in a private hospital and it wanted some public beds. St Vincent's Hospital now has 42 beds and the average bed occupancy is 17. It has no operating theatre, but the diocese has cunningly avoided the terms negotiated by Laurie Brereton when he was Minister in relation to the operation of that particular hospital. People have been encouraged to go to St Vincent's Hospital for their normal public health care. Every Sunday when I attended 6 o'clock mass, what was on the bulletin? "Please use St Vincent's Hospital. It is your hospital." It has never ever been the Catholic Church's hospital. It has been a public hospital owned and controlled by the people of New South Wales. A board has been appointed by the church and a parish priest is a member of that board.
Who owns the land and buildings?
The land and buildings are owned by the church in trust. The Webb family of Bathurst -
It is a public hospital, is it?
It is a public hospital. I am surprised to hear the Minister query that. He knows as well as I do that it is a public hospital; it is funded by the public health system. The Regional Director of Health in Bathurst has provided a summary of matters that could occur at Bathurst if St Vincent's Hospital is allowed to go private. It has 42 beds at the moment and the intention is to build more private hospital accommodation, which will then be split into 30 public and 30 private hospital beds. I have no objection to private hospitals running on a commercial basis - that is up to the people who want to do that. If there is a need for private hospital accommodation and people are prepared to put up the money to build and operate a private hospital and take their chances in the open market, I have no problem with that whatsoever. Some of my colleagues may disagree with me, but I see that some services will only be obtained in country New South Wales by the provision of private hospitals.
Private hospitals are not the answer to the question. There must be a strong public hospital component in any town or city such as Bathurst. In Lithgow, behind the scenes work is proceeding to get the community to build a hospital. If the people in the country are to receive reasonable health services, there has to be a combination of both hospitals. What does the Regional Director of Health of Bathurst have to say with regard to the possibilities in relation to St Vincent's? She has produced three interesting scenarios. In the first she says that St Vincent's could retain 30 public beds and open 30 private surgical beds. This means increasing the number of publicly occupied beds at St Vincent's from an average of 17 to 30. In other words, additional funds will have to go to St Vincent's Hospital to maintain 30 beds. I have written to the Board of St Vincent's Hospital telling them that I oppose any move to have 30 beds, and I have suggested they discuss the matter with the regional director to determine what sort of public bed buy-back system can be put in place after their private hospital has been established.
The regional director says that increased public activity at St Vincent's will result in a funding shortfall for Bathurst Base Hospital, leading to the closure of Ward D and possibly one theatre. So, keeping 30 beds at St Vincent's would result in the closure of a ward at Bathurst Base Hospital, which has been a base hospital for five or six years and has always provided an excellent service. I have been a patient in that hospital and I am aware of the standard of care provided. The regional director states that there will be a reassessment of base hospital status, and reduced access to public services for people in Bathurst and its district. On a cost analysis based on the loss of revenue at St Vincent's and Bathurst Base Hospital, to maintain public funding at St Vincent's through a subsidy, less the savings from the transfer of private patients with the closure of Ward D, and increased visiting medical officer costs at St Vincent's, would cost the State a difference of $3.689 million - to provide semi-privatisation of St Vincent's Hospital.
The regional director's second scenario is to maintain the status quo, that is, to continue to fund St Vincent's at the present level and retain existing services at Bathurst Base Hospital. She says that this means maintaining inefficiencies and duplication between St Vincent's Hospital and Bathurst Base Hospital. Duplications and inefficiencies have been caused because the doctors are referring patients directly to St Vincent's Hospital for medical reasons, which was not the role laid down for St Vincent's. I hesitate to go so far as to say the board of St Vincent's Hospital is devious, but I say they are very difficult to understand. When Hansard
is published the board will know exactly how I feel about it. [Extension of time agreed to
As well as maintaining the inefficiencies with the duplication between St Vincent's and Bathurst, the unresolved pressure on theatres at Bathurst Base Hospital will continue; it would not be resolved. From a cost analysis point of view, the income to St Vincent's will be slightly more than $1 million; the cost to maintain the public subsidy to St Vincent's will be $2.5 million; and the total cost to the people of New South Wales will be $1.5 million. That means
the people of New South Wales, in effect, will continue to fund two public hospitals. Scenario three from the regional director is the one I agree with. It states, "Privatise St Vincent's Hospital and purchase back agreed number of public beds". If that line is followed, I am prepared to accept it. Some of my colleagues would not accept that, but I see it as establishing a balance. The regional director explains that this means increased access to private surgical service at St Vincent's, increased access for public patients, and existing beds will stay open at Bathurst Base Hospital but the case mix will be altered - more palliative care, respite care, mental health care and so on.
On a cost analysis the regional director has worked out the loss of revenue to St Vincent's will be slightly over $1 million; the loss of revenue at Bathurst Base Hospital will be $751,000; savings to the people of New South Wales at St Vincent's through gross operating payments will be $2.5 million; and the savings from the transfer of private patients from Bathurst Base Hospital to St Vincent's will be $662,000. The savings before the purchase of public beds will be $1.4 million. Savings can be used to keep Bathurst Base Hospital functioning at close to existing levels - the case mix is likely to change more to medical than surgical - with the purchase of some public beds at St Vincent's Hospital when they are necessary and not on demand from the medical fraternity in Bathurst because that fraternity is putting as much pressure as it can on the Director of St Vincent's Hospital. They went to the extent of circularising everyone in the district, telling them why this is such a great idea. I am sick and tired of having circulars delivered to me after I have had meetings with directors of St Vincent's Hospital. The directors tell me one thing is happening and a couple of days later a different story is published either in the paper or by circular distributed to every person in the city.
I do not trust the involvement of the church in this matter because I believe the issue is similar to what will happen at Liverpool. If the people of Liverpool have a proposal forced upon them, I believe they will be very much in the same boat as the people of Bathurst are at the moment. I replied to Dr Barrett, the Regional Director of the Department of Health. I indicated that I had written to Mr John Wilson of the board of directors at St Vincent's Hospital suggesting that Mr Wilson contact Dr Barrett to discuss the purchase back of an agreed number of public beds. Those public beds will have to be purchased by St Vincent's Hospital with a maximum payment of $1.4 million if we are to maintain the status quo. The situation with health care in New South Wales is such that if the Minister and the Government have their way we will have an American system the moment they have the opportunity to change it.
I want to finish by making one comment. The honourable member for Ku-ring-gai said, "We have a mandate". I inform the honourable member for Ku-ring-gai: you have not got a mandate to blow your nose; you are a minority government here. One has only to look at the Government's performance towards the end of the last parliamentary session to know that. On the final day of that session the Government threw away all the remaining legislation. Instead of the House sitting through until 11 p.m. it debated seasonal felicitations at 6.30 p.m. and the game was over. I have been in this Parliament for a long time but I have never known the level of animosity that exists now. My advice to Government members is this: you have not got a mandate; you have no form of mandate whatsoever. You are the Government in New South Wales by virtue of circumstances and by the support of the three Independents. That support is forthcoming because the Independents believe that precedent and practice dictates that the party with the most numbers on the floor of the House should have that support. But Government members can forget about the mandate. As I said: you do not have a mandate to blow your nose.
(Miranda - Minister for Health) [11.42]: I lead for the Government in this debate. Before I get to the main substance and content of the bill I should like to cover some points raised today by members of the Opposition. First I refer to those matters that the honourable member for Liverpool was trying to make. He said: let the Minister deny that we are trying to privatise Liverpool Hospital. He asked why the Government is not coming up with the answers, why it is so secretive about this and so underhand about what is happening with Liverpool Hospital. Let me make it clear once again to this House what this proposition is about. The problem the Catholic Church suffers - and so do a range of other non-profit organisations involved with health - is that it is faced with exactly the same problem that faces the public health system.
The new health markets are in other parts of Sydney and other parts of New South Wales. They have grown away from the traditional base where the hospitals are, that is, the inner city area and its narrow perimeter. Just as the public system has to rationalise those hospitals within the inner city area and provide new infrastructure, as well as provide new infrastructure where the needs are in western and southwestern Sydney and other growth areas in the State, the Catholic Church and other non-profit organisations have to do the same thing. If they are to stay in health care, they have to move out of Sydney as their traditional base and start being part of the new markets. What is wrong with that?
People in western and southwestern Sydney are just as entitled to the choices in health care that people in the inner city area or on the North Shore have. The honourable member for Liverpool said that he lived in the eastern suburbs for some time and that he knew the myriad choices he had. He said he could choose from half a dozen hospitals. Well, out in the west people cannot do that, and that is the basis of the problem. The people in western Sydney are entitled
to a choice. They should not be restricted to major public hospitals, without a choice of other types of hospital care, such as that provided by organisations like the Sisters of Charity and others. What is wrong with trying to achieve that for western Sydney? All we have said is that we are trying to achieve that. We are trying to achieve a base for a major health organisation, the Catholic hospitals organisation, in western Sydney so that they can be part of the growth market. We have said that we will look at Liverpool as a start, to see whether it is viable. There is no hidden agenda.
A task force has been formed from St Vincent's Hospital, the Catholic Church and the Department of Health to look at the issues, to see how it can be achieved, whether it is viable, what the problems are and how we can resolve them. That is all that we have done. I can assure this Parliament, the people of Liverpool and New South Wales, that we will move no further - absolutely no further - on that project until the task force reports. I assure honourable members that I will report to this Parliament on the outcome of the task force and I will lay the results clearly on the table. I will make sure that the problems and the resolution process are made transparent, and that everyone is aware of the positives and negatives, because it is a very important health issue in New South Wales for the next 20 years. That is how this issue should be handled.
There is no hidden agenda relating to St Vincent's Hospital - absolutely none; I would not allow it. I can assure the people of Liverpool that they should not feel threatened. The project this Government is fulfilling at Liverpool Hospital, with an investment of $183 million in that part of Sydney, is on time and on budget. We are pushing as hard as we can. It will be finished progressively over the next couple of years and provide new services so that the people of Liverpool will not have to travel miles and miles to obtain health services in the city. We will do that; we will achieve that.
Mr ACTING-SPEAKER (Mr Hazzard):
Order! I call the honourable member for Kiama to order.
The project we are looking at with St Vincent's Hospital will in no way threaten or slow down the process with Liverpool Hospital. We will keep pushing health services to the west, just as we are doing with another project worth about $90 million or $100 million at Nepean, pushing health services to that part of western Sydney. We will keep that on track. Another point mentioned by the honourable member for Liverpool is something that every Opposition member has been taught to use. It is the scaremongering tactic used on so many issues, and now being used with health. The words they use are, "The Americanisation of the New South Wales health system". They say that the Government is Americanising the health system. When they are asked what it means, they do not know; they do not understand. The honourable member for Bathurst said that when he was in Los Angeles he had to go to a hospital and he found that their system was very different from ours. Surprise, surprise: it is!
The American health care system and the Australian health care system are fundamentally different because the American system, unlike the Australian system, does not provide cover for everybody. Every person in Australia has access to the best care the country can possibly provide regardless of their income, status in society, or where they live. However, in America 34 million people do not have health insurance and another 34 million people do not have adequate health insurance. The health care system in American works on the premise that if you can afford it, you can get some of the best health care in the world; if you cannot afford it, you are in big trouble. That does not compare with the health care system in Australia. Every parliament in Australia and every political party in Australia would defend an individual's right to have access to health care. The fact that health care for everyone in Australia is not a political issue makes Australia different from America. Scaremongering is a political tactic and has nothing to do with it.
This debate is about how new and expanded health facilities can be provided for people in the growth areas of Sydney; how old health stock in Sydney can be replaced; and how to keep pace with hugely expensive, rapidly changing health systems involving new technology, new techniques and new medicines, which are all frightfully expensive. How can the people of New South Wales be guaranteed as much quality of access to health care as they require? The honourable member for Liverpool, the honourable member for Bathurst and the honourable member for Kiama are all opposed to the private sector development of health systems and participation with the public, yet on 20th January a report in the Liverpool Champion
referring to the Deputy Leader of the Opposition stated:
He said while St Vincent's was a world-class hospital, its expertise should be extended to hospitals which are worst resourced - such as Campbelltown Hospital - not equally first-class facilities like Liverpool.
He went on to say, "Labor's policy of privatisation on a case-by-case basis is the most effective way of managing the State". Therefore, the Deputy Leader of the Opposition is not saying that private sector development should not be involved -
On a point of order. I ask the Minister to vouch for the accuracy of that statement. Under the standing orders, when the Minister reads from a newspaper, he has to vouch for the accuracy of the statement he is reading.
On the point of order. The Deputy Leader of the Opposition has the right of response. As yet he has not spoken in this debate. I can only quote from the source. I have named the source, given the date and the quotation, and he has every right to respond. That is in accordance with the standing orders.
Further to the point of order. The Minister has to vouch for the accuracy of the report. I ask you, Mr Acting-Speaker, to direct the Minister to either withdraw his statements or vouch for the accuracy of the reports.
On the point of order. The Deputy Leader of the Opposition well knows that is not the case. When quoting from newspaper articles, members should quote only briefly and not read whole entries on to the record. Honourable members can be asked to give the date of a newspaper or correspondence to which they are referring. The Minister does not have to vouch for the accuracy of what the journalist said. If that is what the Deputy Leader of the Opposition is implying, that is not within the standing orders.
Mr ACTING-SPEAKER (Mr Hazzard):
Order! Under the standing orders the only obligation upon an honourable member quoting from a newspaper is to provide the date and the name of that newspaper.
The New South Wales Labor Party has a real problem with health care and during this debate I will demonstrate to the House what Labor parties in Canberra, Western Australia, Queensland and South Australia are doing about joint sector development, working with the private sector to provide huge and expensive expansion in the health system because the public purse no longer has the money. That is the real issue and that is what Port Macquarie is all about. The Government rejects totally the Public Hospital Services (Control of Privatisation) Bill moved by the honourable member for South Coast. All honourable members may recall that the drafting of this piece of legislation took an inordinately long time and it is not difficult to understand why it was sent back many times to the parliamentary draftsman's office before it saw the light of day. It took many months to achieve what was sought by the honourable member for South Coast.
In drafting this bill the honourable member for South Coast has been at odds with himself. On the one hand he has attempted to give expression to his blind ideological opposition to one particular hospital project, that is, the new Port Macquarie base hospital. He has tried to impose upon all honourable members his total ideological opposition to the private sector participating with the public sector in health care. In his second reading speech the honourable member for South Coast said, "The object of this bill is to prevent the control and management of a public hospital by private enterprise, especially for profit".
This bill is intended to prevent any private sector development. I do not know the origins of his total and implacable opposition to the private sector, but obviously he has a real problem with it. It does not matter that the rest of New South Wales lives in a mixed economy with goods and services provided by both the public sector and private sector: the honourable member for South Coast will have nothing to do with it; he does not want any part of it; he is totally opposed, totally blinkered, blind and hellbent on stopping it. Further into his second reading speech it became obvious that he is trying to achieve something else in the bill - something totally opposed to the private sector. He said:
This type of legislation and the re-establishment of a public works committee could ensure that all major government contracts over a predetermined figure, whether they relate to hospitals or whatever, are fully examined.
That is where the conflict is. On the one hand he is endeavouring to make the Government accountable to this Parliament, to be transparent, to have the issues exposed - rightfully so, and I support him in that regard. But, on the other hand, the real objective of this bill is to stop any private sector development at all, so why would any sort of review be necessary? He is trying to create a bill which will provide for Government accountability, but he does not want the system at all. The bill is a farce and is fundamentally flawed.
In his frenzied attempt to prevent the community having a new hospital the honourable member for South Coast has been unable to separate his ideological determination to stop the project from his attempt to create a system of greater accountability over major Government projects, which I am happy to support. In the meantime the Government has made no specific statement about introducing its own legislation to provide the accountability that the honourable member for South Coast wants. The Government is happy to have accountability and transparency but it will not be party to preventing the private sector help the Government to provide additional resources to people, where they are needed. It will do so via a process that is completely open and transparent. This will ensure that any proposed hospital project that involves the participation of the private sector is reviewed by the Public Accounts Committee before the project is proceeded with.
Not to put too fine a point on it, what the honourable member for South Coast is putting forward in this bill is a piece of unadulterated legislative rubbish. It is bad legislation. Clearly, it is the product of an ideologically blinkered mind. The bill is filled with major flaws from start to finish, commencing with its title - Public Hospital Services (Control of Privatisation) Bill. The use of the term "privatisation" is one of many of the fundamental flaws in this bill. It reveals an inability on the part of the honourable member for South Coast to comprehend the difference between privatisation and the initiative by this Government to develop a limited number of public health care projects with the support of the private sector.
The honourable member for South Coast should be aware that privatisation is selling a public asset. Privatisation is about getting out of business. That is what we did with the GIO. The Government is getting away from business altogether. It does not want to be in insurance, it does not have to be in insurance and it does not need to be in insurance. Privatisation is about selling off assets and getting out of business. It is about giving away responsibility for customers and getting out of the market. We are not doing that in health. The Government's initiative will create a new health infrastructure with the participation of the private sector. As yet, no Port Macquarie or Hawkesbury hospital is in place. The assets do not exist to privatise, get rid of or sell those hospitals to the private sector. So how can the Government be proposing to sell them off?
Joint sector development is a more appropriate term to describe the proposed nature of the arrangements between the Government and the private sector in the case of the limited number of hospital projects that the Government has already specified. We are talking about "harnessing the private sector to build and operate infrastructure projects". We are not talking about privatisation - an important and fundamental distinction. Incidentally, that statement was made by the Leader of the Opposition. That is what honourable members opposite want. The Leader of the Opposition obviously understands the principles of private sector participation in the provision of new infrastructure, even if the honourable member for South Coast does not. I will say more about that later. So right from the very title of the bill proposed by the honourable member for South Coast this piece of legislation is riddled with flaws. Let us look at another example. Clause 4 provides:
4. This Act applies to an agreement entered into or proposed to be entered into by or on behalf of the Government, a public hospital authority or a public or local authority:
(a) by which any private person is or is to be charged with the management of the provision of any public hospital services to public patients; or
It seems that the phrase "the management of the provision of any public hospital services" has been drafted to avoid the possibility of inadvertently covering agreements such as visiting medical officer contracts. It appears also that a contract such as the Port Macquarie base hospital contract is not covered. Legally it could be argued that, because of the way in which this bill has been drafted, Port Macquarie is not covered by the legislation, yet that is the intention of the honourable member for South Coast. The words are there to achieve it but the legislation is flawed. It does not do that. Under this services contract the operator will be the provider of services to public patients.
The Government is contracting for services under that contract which is different from contracting for the management of the provision of services. This latter term would apply to management agreements as opposed to operator-provider agreements. For example, a public hospital, being a provider of services, appoints a private manager for the hospital under a comprehensive management contract. Management of the provision of services delivered by the public hospital will form part of the manager's responsibilities. The manager remains just that - a manager - and the public hospital continues to be the provider. In other words, this bill does not even relate to projects such as the Port Macquarie base hospital.
A project in which the private sector is the provider of services would not fall within the parameters of this bill. The honourable member for South Coast might say that that is a mere technicality, but it highlights another hole. Inconsistencies and flaws riddle this bill from beginning to end. Imagine the field-day that the legal profession could have with it. There is enough material in this bill to keep a team of Queen's Counsels fully employed for years. What benefit from that would there be for the people of New South Wales, apart from the rather dubious pleasure of having to pay exorbitant legal fees? There is none. The people of New South Wales would be no better off from the legal feeding frenzy that this bill would set in motion. Let us look at a few more of the flaws. Clause 4 again states that the agreement must relate to the provision of public hospital services. The phrase "public hospital services" is defined to mean, "any medical, nursing, diagnostic, dental or paramedical services, including any preventive health services, provided by a hospital to an in-patient who is a public patient within the meaning of the Health Insurance Act 1973 of the Commonwealth".
The bill points out that these services relate only to in-patients - those people admitted to hospital. So community health services and emergency services, which generally are out-patient services, are not covered by this bill. The bill covers only half a hospital. In the case of Port Macquarie, community health services are subject to a review, which is currently under way. I will put that to one side for a moment. This bill does not even address the provision of emergency services - one of the most fundamental services delivered by any hospital to meet the needs of public patients. The holes in this bill are big enough to drive a Mack truck through. I turn now to the question of exemptions as proposed in the bill.
The bill will exempt certain agreements relating to services to public patients provided at private hospitals where 25 per cent or less of the beds in a private hospital are to be available for public hospital services. This means that a public authority such as the Department of Health would be able to deliver the majority of its services by contracting them out to a number of private hospitals. As long as the contract does not relate to more than 25 per cent of the beds in any hospital it would be exempt under the bill. However, a public authority could deliver only a minor percentage of services through contracting out to a single private hospital. But if this amounts to more than 25 per cent of beds at that hospital it would be caught by the bill.
Obviously, the honourable member's fertile imagination and his ideology got in the way of what he set out to accomplish. Where do the people of New South Wales stand? They would be a lot worse off not only because they would have to pay millions of dollars in legal fees but also because they still would not have the hospital. The honourable member for South Coast is attempting to stop that hospital by introducing this legislation. This bill is about trying to stop the people of Port Macquarie and the people of Hawkesbury from getting new hospitals, which are desperately needed. This bill is about the appalling arrogance of one man who believes he has the right to decide whether or not communities around the State who are in need of new and expanded health care facilities get those facilities. If he gets his way, if he walks away from it and he goes back to the South Coast, who will be accountable to the people of New South Wales, to the people of Port Macquarie and to the people of Hawkesbury who are in desperate need
of health care facilities? The honourable member for South Coast will not be accountable; the Government will. By law, as the Minister, I am accountable.
If the Government is prevented from building those hospitals and providing health care it would be negligent for me as Minister not to provide top quality access to health care. The honourable member for South Coast can walk away from that decision and not be held responsible. The people in the South Coast electorate will not vote on whether the people of Port Macquarie or Hawkesbury get a hospital. The honourable member for Port Macquarie will be accountable at the next election and if we get it wrong it is her head on the block, not that of the Opposition. She is taking the responsibility. The Opposition can make this decision, stop the proposal and walk away from it. I do not see that as fair. What right does the honourable member for South Coast have to condemn the people of those communities to continued pain and suffering, to being stuck on a waiting list longer than is necessary, just because he is philosophically opposed to providing health services this way? If the honourable member for South Coast was open to rational discussion on this issue, then I am certain that this flawed, this sick and sorry bill would not be unnecessarily wasting the time of the House.
This bill is the product of an ideologically blinkered mind. The honourable member for South Coast is not normally coming from that angle, but on this angle his mind is totally closed to the need to find a practical solution to the problems of alternative sources of funding for new health infrastructure. His mind is closed to the suffering of the people who would be prevented from having increased access to quality health care as a result of the bill. Since the issue of private sector involvement in the provision of public health services was first raised in this State, the honourable member for South Coast has expressed his total and intransigent opposition to the concept, for reasons best known to himself. On one occasion last year when I discussed the matter with him, he indicated that even if the Government resolved his concerns about the issue, he would not support the concept. That is a clear indication of a mind that is ideologically fixed and implacably closed to rational discussion on the issue. I have not met with him or discussed the issue with him since, because he closed his mind on that point.
It is a sad and sorry state of affairs that the health care needs of people in this State could be placed at risk because of the irrational beliefs and the blind prejudice on this issue. I would be only too happy to continue to catalogue the failings, the flaws and the holes in this bill in very sorry detail, but I believe the time of the House will be better served at the moment by focusing on the Government's initiative that this bill is aimed at preventing. The need for alternative sources of funding to develop and expand public health services is clear. The people of New South Wales expect and deserve the very best medical care that modern technology has to offer. They expect to be treated in a modern hospital equipped to deliver the services that a community such as ours requires: hip and knee replacements, coronary bypass procedures, cornea transplants, geriatric services, and all the other miracles of modern medicine that are becoming increasingly commonplace. People have an expectation of, and are entitled to, the highest quality care that the Government can provide.
The State Government, under the terms of the Medicare agreement with the Commonwealth, has a statutory responsibility to ensure that everybody in this State has access to quality health care services, and if they elect to be treated as public patients they are entitled to receive these services free of charge. The Government is statutorily committed to that responsibility. Despite any misleading claims by the Opposition or by the honourable member for South Coast to the contrary, the development of any hospital infrastructure project that involves the participation of the private sector has no effect on our statutory responsibility to ensure access to quality health care free of charge to anyone who seeks it. But what Opposition members, including the honourable member for South Coast, seem to completely misunderstand is that the Government does not have to own the facilities in order to ensure that people obtain the access they require. That is clearly recognised by the Federal Labor Government, the Labor governments in Queensland and South Australia, and was recognised by the former Labor Government in Western Australia.
About 90 per cent of nursing home beds in the State are owned and operated by the private sector, and the Commonwealth Government picks up the tab. It pays for the public patients in private nursing homes. Does the Federal Government have an ideological problem with these services being delivered through the private sector? Obviously the Federal Government does not. The Federal Labor Government has contracts with a number of private sector hospitals to deliver specific health care services to the veteran community of the State. So the veteran community and the Federal Government see that it is good enough to contract services for treatment of veterans in private hospitals when needed. It is good enough for them. Does the Opposition have an ideological problem with that? Obviously not.
In his pre-election speech delivered only a week or so ago the Prime Minister, Mr Keating, indicated that if re-elected the Government would contract out services for public patients to private sector hospitals in an attempt to reduce the growing waiting lists of people seeking treatment in public hospitals. He indicated that he would allocate $25 million to fund the program. Does Mr Keating have an ideological problem with entrusting the health care of public patients to the private sector? Obviously not. The Federal Government has crossed the line; it does not have an ideological problem with the private sector working with government to deliver health care. Yet consistently in this State members of the Opposition, a handful of hardliners in the union movement, and a few old-time reactionaries such as the honourable member for South Coast, claim that contracting out
public health care services to the private sector will mean the end of health care as we know it today. What absolute nonsense. What unadulterated nonsense.
New South Wales has an outstanding record of achievement in meeting the health care needs of the people of this State, but for how much longer can we keep pace with the development of new health care infrastructure to meet the community's growing health care needs? That is the problem. A very strong health care system operates today, but it is coming under more and more pressure. The Federal Government is now funding health care in New South Wales for only 16 weeks of the year. This State's health system is recognised as one of the strongest in Australia, because the New South Wales Government has bailed the Federal Government out and keeps topping up the funding. The Government has added $1.5 million to the health budget since coming to office in 1988. The Government is doing its bit, but can see no relief from the Federal Government, and is coming to the end of its ability to continue pouring money into health. That is why the Government is concerned about the future.
The years of Labor in New South Wales were years of neglect for the health care system. People seem to forget that. One need only look at the capital works program for health infrastructure under the former Labor Government to realise that, after 12 years in office, in its last year in office it allocated a little over $200 million for health infrastructure works. That was in 1988, and that was a big increase on allocations in most of that Government's earlier years in office. In its last year in office $200 million was the expenditure on health infrastructure - after years of spending much less than that. When this coalition Government came to office in 1988 it embarked upon a determined program to catch up on the backlog of work that had been left undone.
This Government is currently spending, and has been since it came to office, approximately $300 million a year on upgrading health infrastructure in the State - an increase of more than 50 per cent on the amount expended by the previous Labor Government. This Government is spending $300 million a year in the worst recession in 60 years. The money is not coming from the Federal Government, which does not provide funding for infrastructure. The New South Wales Government has to do that itself, and it does it proudly. That is an enormous amount compared with expenditure in other States, though it is still not enough. The forward capital works program for health infrastructure is already fully committed, but it can address only the areas of greatest need.
I shall give honourable members an indication of the major capital works projects in progress at the moment. They total $1,582 million worth of work and include projects such as Liverpool Hospital, $183 million; the mental health plan, $178 million; Nepean Hospital, $88 million; the Children's Hospital going to Westmead, $313 million to provide young families of western Sydney with a children's hospital; and the Sydney Eye Hospital, $151 million. The list goes on and it totals, as I said, $1,582 million worth of work in progress. No one can justifiably say that the Government does not have its priorities right for capital commitment. A further $2 billion backlog of work is due to the years of neglect under Labor. That is the problem. More than $1,500 million worth of work is in progress and still another $2 billion worth of work is needed to be done for which the State does not have the resources. Demand for services continues to grow at a rate of about 2 per cent a year. Let me examine some of the work that needs to be done. Will anyone deny that these projects are necessary? Hawkesbury, Maitland, Walgett, Coffs Harbour, Byron Bay, Lithgow and Shoalhaven hospitals all require work. The honourable member for South Coast has constantly made representations to me about the need for further redevelopment of Shoalhaven Hospital. The Prince of Wales Hospital needs upgrading, as does the Royal Hospital for Women. Wollongong Hospital needs work done. Westmead hospital also requires additional expenditure. The Hornsby Hospital stage one redevelopment will cost $40 million. Campbelltown Hospital is on the list and Sutherland Hospital wants 10 new projects at a cost of $70 million.
What do we get?
I mentioned some hospitals in the honourable member's electorate, including the Campbelltown expansion, on which we want to spend $45 million. All of those projects add up to $2 billion. They are the works that need to be done, but the capital works program has been allocated for the next three years or so. How will these projects get done? We need more money for upgrading and expanding the hospital system. Where will that money come from? That is the question being asked by this Government, and indeed every State government in this country. Many overseas governments are grappling with the problem of where to get the capital to support everexpanding demand for health care services. Not enough public funds are available to go around. The Government in Canberra is not going to reach deeper into its pockets, no matter which party wins the Federal election. The Federal Government has a huge debt problem. Its funding for health has fallen to a rate that would provide health care services for only 16 weeks of the year in New South Wales. We do not expect to get a great deal of relief. Where will the money come from?
The only practical and viable source of additional funding is the private sector. The notion of private sector involvement in funding and operating public services is neither new nor startling, no matter what the honourable member for South Coast thinks. Even the Leader of the Opposition acknowledges that. As I mentioned earlier, in one of his periodic backflips and pirouettes on the issue he described the concept of drawing on private sector resources as, "harnessing the private sector to build and operate infrastructure projects". Clearly hospitals are infrastructure projects, no matter how one regards them. None of Mr Carr's Labor Party colleagues appears to have difficulty comprehending that simple fact. North of
the border, in Queensland, Labor Party Premier Goss recognised that a hospital is an infrastructure project. In fact, his Government has published a white paper setting out guidelines for private sector involvement in infrastructure development, including hospitals. The document sets out the Labor Party policy guidelines. It is headed "Private Sector Involvement in Infrastructure Development in Queensland". I make brief reference to the document at page 4:
The public sector has traditionally accepted the role of infrastructure builder, owner and operator. However, current fiscal restraints on Government, and the maintenance of strong population growth mean that Governments alone are no longer able to meet all infrastructure needs.
That is another Government, a Labor Government, which recognises that governments alone are no longer able to meet all infrastructure needs. The quotation continues:
The private sector has recognised this and has shown increasing levels of interest in public infrastructure as an investment class.
The Government's objectives in publishing the guidelines are to:
provide an enhanced capacity to meet the demand for the development of new infrastructure assets; and
ensure an optimal level of efficiency in the construction and operation of the State's infrastructure assets.
I shall make a further quotation from the document, so that members can be sure the document is speaking about hospitals. This quotation is under the heading "Social Infrastructure":
Social infrastructure includes schools, hospitals, prisons and other public buildings used to provide services for which direct user charges do not usually apply or, if they do apply, are insufficient to provide a direct financial return on the project.
Clearly the Queensland Government is committed to ensuring that the private sector helps it to develop important infrastructure projects. In Western Australia the former Labor Government of Dr Carmen Lawrence invited private sector participation in the provision of new infrastructure, including hospitals, in a publication entitled "Investing in Infrastructure: Guidelines for Private Sector Participation in Public Infrastructure". That is another Labor Government which, when in office, saw the necessity to move down this path. I quote from page 1 of that document:
The Western Australian Government welcomes the involvement of the private sector in providing public infrastructure.
It believes the private sector can play a greater role in efficiently providing essential public facilities and services. In this way, the private sector will complement the activities of the public sector, which traditionally has provided the State's infrastructure.
Our rapidly expanding state economy is stimulating infrastructure requirements. Competing demands for government funds have made the involvement of private enterprise the logical and sensible direction for the future.
I hope the honourable member for South Coast takes note of that. That is a logical and sensible direction for the future. It continues:
Private investment in infrastructure is relatively new for Australia even though it is a well established and successful formula elsewhere in the world.
That was the view of the Labor Government. The schedule of capital works projects includes a list of hospitals that will invite private sector participation - a Carmen Lawrence government. In the United Kingdom the Leader of the Labour Party Opposition, John Smith, has announced that he, too, has seen the light and now recognises the need for private sector participation in the development of health infrastructure. The hard core Labour Party of England, which for years has believed in a socialist health system, has changed direction. It is a view endorsed from one end of this country to the other, in industrialised countries around the world and by the mainstream of political thought worldwide.
It is not surprising that the New South Wales Opposition and the honourable member for South Coast are so out of step with the mainstream on this issue, given that they are out of step with the mainstream of political thought on so many issues. They are 10 to 20 years behind what is happening around the world. What is their solution to the problem of keeping pace with the relentless growth and demand for health services and the growing shortfall in public funding for health infrastructure? The Opposition and the honourable member for South Coast do not have a solution. They seem to be labouring under the rather primitive cargo cult philosophy that somehow, some time, somewhere, extra money will fall miraculously out of the sky or grow on trees or shoot out of the ground.
That is the fundamental problem. It is not responsible for honourable members opposite to say we cannot do it when everyone else in the world is doing it. I am happy to say, "Fine, stop us" - but how will the problem be addressed? If there was another solution other governments would have found it and we would have examined and embraced it. In the meantime the people of New South Wales - especially in areas where access to high quality facilities is limited - are expected to wait. On the other hand, the Government has developed a practical and viable solution worth trying and testing. The Government has initiated this small but significant program of private sector participation in the development and expansion of our health care system. It is expected that the Government will look at a maximum of five projects, but I suspect that before the next election we will be happy to have three projects under way. Those projects can be clearly tested to see whether the delivery of service is adequate and the community has a right to make a determination whether of the proposal is worth continuing.
The Government does not have a secret agenda. I make that clear to the honourable member for South Coast. Everything is exposed, open and transparent, which is what we want for this and future projects. The new Port Macquarie base hospital is nearing construction stage. This project is a milestone in the development of new hospital infrastructure and the delivery of expanded public health care services. It is based on contracting out services to the private sector,
thereby providing the basis for private investment in much needed new hospital infrastructure in a way that complies with Loan Council guidelines. It will accelerate the pace of future infrastructure development and provide the people of Port Macquarie with a new expanded hospital within the next two years - six years earlier than otherwise would be possible.
This new, privately funded and operated hospital will provide the best possible care to the local community, delivered by the same dedicated team of clinical staff that work in the existing district hospital. Currently 1,800 people a year have to travel outside the district to Sydney, Lismore or Newcastle, for specialised treatment. In 1991-92 the hospital operated at 85 per cent occupancy. The medical and surgical wards averaged occupancy rates in the 1990s. Surgical lists are frequently cancelled or reduced due to the overflow of medical patients into surgical beds. The average length of stay is four and a half days - one of the lowest in the State, despite the community having one of the oldest populations in Australia. This will become worse and that is why action must be taken now. By 1994-95 it has been estimated that the hospital will need to provide 9,000 separations a year, yet the hospital administration and the Department of Health know that it has only the capacity for 7,000 separations a year. In other words, the Hastings District Hospital is at saturation point and waiting lists will grow. The shortfall in funding for new health infrastructure means it simply is not possible to allocate beds for a publicly funded hospital before 1995-96 at the earliest.
The Opposition has indicated that it could do no better. It has agreed with the current projects list and could not allocate funds to start until 1995-96. We all know that it will be many years before the project is completed. In fact, the Deputy Leader of the Opposition, in a letter to the local municipality, has indicated that a Labor government would make a start on a publicly funded hospital at the same time as the Government, but he could give no assurance as to when the new hospital would be completed. The Government knows that because it knows what other projects need to be commenced at the same time. The Opposition cannot give that commitment, and it knows it. I can only presume that the honourable member for South Coast is not worried in the slightest about the health care needs of the people of Port Macquarie because this bill is aimed at stopping the Port Macquarie hospital and the honourable member for South Coast has no viable, alternative way of providing a solution to the problem. He has the ability to stop the hospital going ahead but has no ability to deliver one.
Meanwhile, the Government intends to honour its responsibility in providing access to quality health care for the people of this State, despite the shortfall in available public funds. Under the services contract model of the type being delivered for Port Macquarie the Government is clearly specifying the required standards of care and has established a system of accountability to ensure those standards - and no one has questioned that; they are very high standards. Under this model of health care, delivery access to services is based on clinical need - that is essential. Access to health care must be based on clinical need. This applies to public and private patients, as it does already across the State's public health system. This assessment of clinical need is clearly the responsibility of clinicians. Clinicians decide who, on clinical needs, should go into hospital and any clinician who does not should be dealt with. Apart from the new modern building and equipment, patients seeking health care at the hospital would not notice that it is any different to a traditional publicly funded hospital. Public patients at Port Macquarie will continue to be treated free of charge and the quality of care will be as good if not better than that provided in the public system. This is required under the terms of the service agreement.
That is what the Government initiative of private sector participation in health infrastructure is all about - providing the people of the State with increased access to high quality care. That has to be our objective. What does this bill have to offer the people of New South Wales? Precisely nothing. Absolutely nothing. This bill will deny the people of New South Wales the benefits of upgraded and expanded free public health services. That is what we are talking about. This bill will stop the Government fulfilling its requirement to deliver expanded free public health services. This bill will delay the development of much needed new hospitals delivering high quality medical treatment; it will cost the people of New South Wales a fortune in legal fees and court cases - precious dollars that should be allocated directly to the health budget. This bill will achieve nothing. What is more, this bill is redundant. There is absolutely no need for it, and let me point out why.
The Government has already given notice of its intention to introduce legislation that sets out an open and transparent process for dealing with new hospital developments involving the private sector. The legislation has been drawn up to ensure that any proposed project for the development and operation of a hospital providing public health services involving the participation of the private sector is reviewed by the Public Accounts Committee before the project is proceeded with. Before I make a decision to proceed with the project it will be examined by the Public Accounts Committee which will report to this Parliament, and the Parliament can examine the matter. Though the Government's bill will provide the Parliament with the opportunity to review projects of this type, this bill aims to transfer the executive power of government to the Parliament, and for one reason only - to stop the projects.
Within the Westminster system of parliamentary democracy, under which this country operates, it is the responsibility of the Minister of the Crown to make executive decisions on the implementation of government policy within the laws provided by this Parliament. Ultimately, the Minister is accountable to the Parliament for the performance of these executive functions. The bill proposed by the honourable
member for South Coast sets out to remove that executive power from the Government, from the Minister, and to vest it in the Parliament. The Government will not surrender its executive powers to Parliament. Indeed, no Westminster government would surrender those powers. If the honourable member for South Coast wishes to change the system of parliamentary democracy under which this and every other government in the country operates, let him take it to the people at the next State election. For the time being, as far as this Government is concerned, it is simply not on.
It is at this stage where there is conflict in the bill. The ideological side of the bill introduced by the honourable member for South Coast seeks to stop private sector involvement in health care - he said that in his second reading speech and it is stated in the bill. The matters of accountability to the Parliament, transparency, justification, ensuring the community gets a deal, are matters for which I as Minister am accountable to the Parliament, and I am happy to be so. The bill the Government has drawn up clearly follows that path and does not get caught up in the difficulties of the bill from the honourable member for South Coast. I ask the honourable member to look at the bill clearly. I would be more than happy to discuss the bill with him on the proviso that he cannot use the health system to hijack the responsibility of Government to try to achieve what he wants - to have this House decide what capital projects a government can or cannot do, because that is not the Westminster system. If he wants to change that, he should introduce a bill to follow that path and not try to come in the back door through this project. The honourable member should have a full and open public debate about changing those powers, and we shall see where that takes him.
I wish to draw to the attention of the House one other matter in relation to this bill, and it is with disappointment that I must do so. At the close of his second reading speech on this bill the honourable member for South Coast made what I consider to be an unprincipled and cowardly attack on a senior member of staff with the Department of Health, Mr Robert Dash. Apart from the reference to Mr Dash being of no relevance to this bill, the matter to which I take particular exception is the unwarranted attack on a senior member of the public service who is not in a position to defend himself from these cowardly allegations. That is all they were; they had no substance. The honourable member for South Coast alleged in his second reading speech that, "The abuses, pain and suffering and the 40 deaths at Chelmsford Private Hospital have a direct result to this contract" - the contract for the new Port Macquarie base hospital. What utter rubbish!
The honourable member for South Coast goes on to make wild assertions against Mr Dash, who is the manager of the private hospital section of the department. The honourable member for South Coast has tried to use the denigration of a public servant to get his way with this bill. The honourable member for South Coast went on to quote, as he claimed, from the report of the royal commission into deep sleep therapy. He claimed that Mr Dash had in fact agreed to the drugs regime used at that hospital. As Minister responsible for the department, I have no intention of letting the honourable member for South Coast get away with this despicable and unprincipled attack on a public servant who has no opportunity to defend himself. First, let us get the facts right. As we all know, the honourable member for South Coast is not averse to letting the facts get in the way of some of his more outlandish and outrageous allegations. So, the first fact to get right is this - the honourable member for South Coast was not quoting from the report of the royal commission into deep sleep therapy, as he said; he was quoting out of context from the transcript of evidence before the commission. It is an important distinction. It is just one of the misrepresentations the honourable member for South Coast made in his speech about Mr Dash.
The honourable member for South Coast claimed that Mr Dash "sought the approval of Dr Bailey's standardised drug regime, even though he knew it was dangerous". It should be placed on the record that in fact Mr Dash sought approval of the form in which the standardised drug regime was authorised by Dr Bailey - and not the regime itself - which is what he is supposed to do. It should also be noted that the breach of the regulations referred to by the honourable member for South Coast related to the method of supply of take-home doses of medication to patients being discharged from Chelmsford hospital, and not to the standardised drug regime used by Dr Bailey. Mr Dash was the senior pharmacist with the poisons branch between 1966 and 1975 - a long time ago. Volume seven of the report of the royal commission into deep sleep therapy deals with the response of the Government and its departments to the Chelmsford events. The history of the poisons branch and its response to the Chelmsford events is dealt with from page 217 to page 250. If the honourable member for South Coast has not already read those pages, he should, rather than quote out of context from the transcripts. Mr Justice Slattery concluded this section as follows:
In coming to conclusions about any culpability of the branch or individual officers it is important to bear in mind their area of responsibility. The deep sleep therapy program was not such an area.
Had they used breaches which were within their responsibility to attempt to influence the program they may well have been criticised for unnecessary bureaucratic intervention and indeed for abuse of the powers they had to achieve purposes outside their jurisdiction.
Another quote is:
In retrospect I think it would have been preferable if they had taken a stronger line but I do not think in the historical context of the circumstances and in the light of the knowledge they had at the time either the branch or the individual officers are open to criticism.
Of Bob Dash specifically, Mr Justice Slattery concluded that:
Mr Dash impressed as an able administrator although in the early years he was inexperienced in the bureaucracy.
That is hardly the impression that the honourable member for South Coast was attempting to convey. But, of course, the reputation of a senior and well respected officer of the Department of Health means little when the honourable member tries to tie in these outrageous allegations with this bill. It is just inexcusable. I usually expect better of the honourable member for South Coast and I usually get better from him. His deliberate and misleading attempt to malign Bob Dash must be condemned by all members of the House who hold dear the principle of an objective and politically non-aligned public service in this State. It was an unprincipled and cowardly attack by the honourable member for South Coast and one that he should be at pains to avoid in the future, regardless of how emotional the issue or how strongly he feels about it.
Since 1983 Mr Dash has had increasing responsibility for the administration of private hospitals legislation. In fact, he has been a major worker in producing a range of legislation based on his experience, which has strengthened the system so that many of the problems of the 1970s have been removed. He was involved in drafting the Private Hospitals and Day Procedure Centres Act 1988 and the private hospitals regulation 1990, and in developing the private hospitals inspectorate into a more efficient and effective unit. The House should be aware that Mr Dash is due to retire from his position with the department at the end of the month. To launch a deliberate attack on him, with a view to inflicting a stain on his character at this stage of his career, is something I find deplorable.
This bill has already occupied far more time of the House than should have been devoted to it. It is destructive; it is obstructive; it is redundant; and it has been ill-conceived from start to finish. It is just straight out bad legislation. It will not achieve what the honourable member for South Coast wants to achieve. The Government rejects the bill and calls on members opposite to do likewise. Let me say this to the honourable member for South Coast and to members of the Opposition: upon rejection of this bill by the House the Government gives an assurance - and I give that assurance - that it will proceed with the bill already on the notice paper to ensure that each private sector development proposed will be reviewed by this Parliament before a decision is taken by the Government on whether to proceed. This accountability to Parliament is the right and proper role of Parliament under the Westminster system, and that is what we are trying to achieve. We want to achieve that accountability, but at the same time fulfil our responsibility as a government and my responsibility as a Minister to deliver improved health care services to the people of New South Wales. The Government opposes the bill.
Debate adjourned on motion by Dr Refshauge.
[Mr Speaker left the chair at 12.53 p.m. The House resumed at 2.15 p.m.