Ms HALL: My question without notice is directed to the Deputy Premier, Minister for Health, and Minister for Aboriginal Affairs. What impact are the Howard Government’s changes to aged care having on the health system in New South Wales?

Dr REFSHAUGE: It has been a traumatic two weeks for many of the frail and elderly in our community since the Federal Government made changes to aged care. Those uncaring changes have left older people confused and uncertain about their future. It is a cruel blow. The Federal Government has failed to realise that the tentacles of its ill-conceived Aged Care Act are reaching out into other areas. There can be no doubt that the Howard Government’s heartless policies in aged care are already having an impact on the health system. The effects are already being seen in our public hospitals. With the uncertainty surrounding these changes and the imposition of exorbitant up-front fees, elderly patients will want to stay in hospital for as long as possible to delay paying the new accommodation bonds.

Mrs Skinner: They will be lucky to get into them in the first place.

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Dr REFSHAUGE: The honourable member for North Shore would do better to look after high school children on their muck-up day. She might have some influence on kids in the private school system. She is their local member; maybe she can look after them, get them on the straight and narrow. The latest figures show that across Sydney, including the Illawarra and the Hunter, 322 elderly people are waiting in hospital for nursing home placement. The Federal Government’s changes are blocking people coming into nursing homes and hostels and putting increased pressure on acute care beds. At the same time older people are not receiving the most appropriate care.

There are also other effects. Aged-care assessment teams are being placed under great pressure. The geriatricians, nurses, social workers and other staff who make up those teams are primarily employed through Commonwealth funding. The State supports this program through the provision of infrastructure. Aged-care assessment teams determine whether elderly people need hostel or nursing home care or can continue living in the community with the provision of support services. Yet the Howard Government has cut funds to that program, resulting in the cessation of a pilot program in dementia care. The Howard Government is asking older folk to sell the family home and to pay up-front fees of up to $200,000 to go into a nursing home. As a consequence more than 300 people are choosing to stay in hospital rather than seeking appropriate care in nursing homes, and that is not fair.

Mr SPEAKER: Order! I call the honourable member for Coffs Harbour to order.

Dr REFSHAUGE: Anecdotal evidence has shown that some nursing home proprietors are trying to pressure aged-care assessment teams to give priority to assessing the more wealthy elderly patients, to give the wealthy the nod to go into nursing homes, keeping poorer people out. This would allow nursing home proprietors to receive the up-front fee. So much for equity under the Howard Government. Clearly, the coalition’s definition of fairness is a two-tiered system. When John Howard talks about looking after the family, he does not mean grandma and grandpa. It is a case of making grandma and grandpa pay, getting rid of the family home, keeping them inappropriately in a hospital, thereby missing out on aged care.

This results in one level of care for the well off and another for the disadvantaged. No wonder the honourable member for Vaucluse is on the phone; he is looking after his elderly, rich constituents. Some people are being required to pay an up-front fee of $200,000. The Howard Government has cut funding for public hospitals and for the public health system. It was a cut last year of $34 million to our public hospitals, with another $34 million this year. There are cuts to special purpose programs, such as AIDS and women’s health services - including the closure of the family planning clinic at Parramatta - and the $34 million cut from the Commonwealth dental program.

The Howard Government is directly targeting health care services for those who cannot afford them. Older people have been targeted in particular with cuts to aged care and to the dental program. Because of the Federal Government’s cuts, approximately 272,000 fewer people across New South Wales will receive dental care. Some 230,000 of the 272,000 are pensioners and health care card holders. Funding levels to this extremely vulnerable group have been cut by 47 per cent because John Howard removed his contribution, yet the Opposition says not a word.

Mr SPEAKER: Order! I call the honourable member for North Shore to order. I call the honourable member for Coffs Harbour to order for the second time.

Dr REFSHAUGE: Members of the National Party are aware of that because some 100 dentists either are having to sell their practices or are unable to provide services.

Mr SPEAKER: Order! I call the honourable member for Barwon to order.

Dr REFSHAUGE: The National Party and Labor Party know how much this is hurting people in the bush but the Liberal Party has walked away from them again. When dental programs are cut for elderly people, oral disease increases and they have difficulties with self-esteem and nutrition. This Government increased its contribution to the dental health program but the Federal Government has cut that program.

Mr SPEAKER: Order! I call the honourable member for North Shore to order for the second time.

Dr REFSHAUGE: All we hear from the Opposition is, "Good on you, John Howard." It is not "Good on you, John Howard" when one is looking for a nursing home, a hostel or dental care for the elderly. This Government is prepared to stand up for the elderly in this State and take on John Howard, but the Opposition does not have the guts to do the same.