Legislative Council; General Purpose Standing Committees; Health And Aboriginal Affairs

The Hon. A. B. Kelly
The Hon. Elisabeth Kirkby
The Hon. Dr B. P. V. Pezzutti
The Hon. Helen Sham-Ho

The Hon. Dr A. J. Refshauge, Minister for Health, and Minister for Aboriginal Affairs

Department of Health
Mr M. Reid, Director-General

Department of Aboriginal Affairs
Mr D. Gates, Acting Director-General

Health Care Complaints Commission
Ms M. Walton, Commissioner


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CHAIR: I declare this General Purpose Standing Committee open. I have been advised by the Opposition Whip that the Opposition wishes to replace the Hon. Jennifer Gardiner with the Hon. Helen Sham-Ho. I remind Committee members that at the hearing on 2 June 1997 the Committee authorised the broadcasting of these public proceedings. Should it be considered that the broadcasting of these proceedings be discontinued, a member will be required to move a motion accordingly. The order of procedure will be the Health Department, the Health Care Complaints Commission, and the Department of Aboriginal Affairs.

The allocation of time for questions is as follows: the Opposition, 30 minutes; the Government, 30 minutes; the crossbench members, 30 minutes; the Opposition, 25 minutes; the crossbench members, 25 minutes. The Government will forfeit its final 25 minutes of questioning. At this meeting the Committee will examine the proposed expenditure from the Consolidated Fund for the portfolio areas of the Health Department, the Health Care Complaints Commission, and the Department of Aboriginal Affairs. Before questions commence, some procedural matters need to be dealt with.

While paragraph 7 of the budget estimates reference provides that a member of a committee and any Minister present to answer questions may have staff present to assist them during the hearing of evidence and may refer to those staff at any time, I remind members' staff and any other persons that they should take care not to interrupt proceedings and observe the usual courtesies that apply to a meeting of the House or of a committee. Where possible, messages for members should be given through the attendant on duty or to the Committee Clerks. On 4 June the Legislative Council resolved that the press and public be admitted to proceedings of these estimates committees. Legislative Council Standing Order 252 provides:

Evidence taken by any Select Committee of the House, and documents presented to such Committee which have not been reported to the House, may not, except with the permission of the Committee, be disclosed or published by any Member of such Committee or by any other person.

In reporting the proceedings of this Committee, as with reporting the proceedings of both Houses of Parliament, the media must take responsibility for what it publishes and what interpretation it places on anything that is said. In order to accurately complete the Questions and Answers paper, the Committee Clerk requires that members complete and sign the appropriate form when a question is taken or given on notice. For the benefit of members and Hansard, I ask departmental officials to identify themselves by name, position and department or agency before answering each question. I remind Ministers and members that each question is limited to one minute and the reply to four minutes.

The Hon. Dr B. P. V. PEZZUTTI: I refer the Minister to Budget Paper No. 3, Volume 2, page 485, subprogram 49.2.2, Overnight Acute Inpatient Services and to page 487, subprogram 49.2.3, Same Day Acute Inpatient Services. Given that the Government's policy designed to reduce waiting lists by restricting procedures carried out in public hospitals has been reversed, what funds will be available in 1998-99 to reduce waiting lists at St George Hospital, Sutherland Hospital, Prince of Wales Hospital, St Vincent's Hospital, the New Children's Hospital and the Royal Hospital for Women?

Dr REFSHAUGE: First, a Government policy was not reversed; the proposal had no merit. It was not endorsed by the Government or the department. Second, the budget -

The Hon. Dr B. P. V. PEZZUTTI: Is this one of the decisions you make after Mick has put his foot in it?

Dr REFSHAUGE: Madam Chair, I find that offensive and I ask the member to withdraw that remark.

The Hon. Dr B. P. V. PEZZUTTI: There is nothing offensive in that remark, Madam Chair, but if the Minister takes offence I am happy to withdraw.

Dr REFSHAUGE: In regard to the question of specific allocations to hospitals, that has not been finalised as yet. It will not be long. Those processes are going through at the moment.

The Hon. Dr B. P. V. PEZZUTTI: Will the Minister release those publicly when they are announced?

Dr REFSHAUGE: The area health budgets are regularly released publicly.

The Hon. Dr B. P. V. PEZZUTTI: On the basis of that answer, I again refer the Minister to Budget Paper No. 3, Volume 2, page 486, subprogram 49.2.2, Overnight Acute Inpatient Services. How can the Minister blame record high waiting lists on lack of funding when the money allocated for overnight acute inpatient services was underspent by some $6.6 million in 1997-98? Will the Minister ensure that all funds allocated in 1998-99 are used?

Dr REFSHAUGE: The variation represents a refinement of the programs. It is not an
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underspending. The money was inappropriately allocated to that area and has been reallocated to the appropriate area.

The Hon. Dr B. P. V. PEZZUTTI: On the basis of that answer, again, how can the Minister blame record high waiting lists on lack of funding when money allocated for same day acute inpatient services was underspent by $525,000 in 1997-98? Will the Minister take steps to ensure that the 1998-99 allocation is fully expended?

Dr REFSHAUGE: There is again a program definition about what funding is for each individual item. As the honourable member knows, this is trying to be more specific than in the days of the coalition Government when those items were not separated. We are trying to get better information, and sometimes during the course of the year, say, in this case for day surgery, funds should have been allocated to a different part of the portfolio. There is no underspending.

The Hon. Dr B. P. V. PEZZUTTI: I am at a loss to understand that, given that these are your budget papers. The year before they were your budget papers and the year before that they were your budget papers. Will the Minister further explain why there has been underspending on both the acute overnight admissions and the same day inpatient services? He has given a most unsatisfactory answer.

Dr REFSHAUGE: It may be unsatisfactory to the honourable member but the reality is that it is important to make sure that the allocation is appropriately identified and put into the appropriate budget item, and as happened in your Government's time, occasional flaws needed to be corrected. I assure the honourable member that there has been no underspending of either inpatient services or day surgery.

The Hon. Dr B. P. V. PEZZUTTI: Given that the Minister must approve each area health service's budget along the allocated line items, has there been significant reinvestment of acute overnight admission money into other line items?

Dr REFSHAUGE: I do not understand the question.

The Hon. Dr B. P. V. PEZZUTTI: Minister, as recently as last week acute surgical services were withdrawn from the Mullumbimby and District War Memorial Hospital and the $220,000 saved was diverted to community health services. Is that something that happens across the board, with your knowledge and approval?

Dr REFSHAUGE: There are a whole range of changes that occur in line with best practice in conjunction with discussions with the health system, those employed with it, those who are contractors for it, and the community, to improve the quality of care and the range of services. The money available this year to health has been fully spent. There is no underspending on health services, but at times there are areas where things come up that have a significant priority and obviously funding needs to be spent for those.

The Hon. Dr B. P. V. PEZZUTTI: Is the Minister saying that money allocated to acute overnight admissions can be used for any purpose and, therefore, that money allocated by him to various area health services that is underspent is transferred for spending in other parts of the portfolio?

Dr REFSHAUGE: No.

The Hon. Dr B. P. V. PEZZUTTI: I refer the Minister to Budget Paper No. 3, Volume 2, page 479, subprogram 49.1.1, Primary and Community Based Services, line item "Patient fees and other hospital charges". Will the Minister explain how the 44 per cent increase in retained revenue patient fees and other hospital charges is to be achieved in 1998-99 over the 1997-98 budget figure?

Dr REFSHAUGE: There is no specific direction to increase fees. However, fees often go up in line with the consumer price index. There are a number of areas in which the fees may change. One is that patients may be more keen to use their private insurance, if they have it, than they have been in the past. Then, I think, this is probably more than for primary and community-based services.

The Hon. Dr B. P. V. PEZZUTTI: Minister, that does not explain the increase in retained revenue that you anticipate.

Dr REFSHAUGE: There is an expectation that, as a result of discussions and proposals by the Federal Government in regard to veterans affairs, increased patient charges could be quite significant.

The Hon. Dr B. P. V. PEZZUTTI: The 1997-98 patient fees and charges are expected to raise $10.8 million in primary and community-based services, yet your advice was that figure was 36 per cent greater than that. Will you explain your better than expected result?

Dr REFSHAUGE: We got more in than we expected.

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The Hon. Dr B. P. V. PEZZUTTI: Could you explain how and why and under what circumstances?

Dr REFSHAUGE: Patients pay fees. We provide services that are not patient-direct services but are charges the hospitals have made. We received more in revenue than we predicted.

The Hon. Dr B. P. V. PEZZUTTI: Would they be retained by the area health services that raised them?

Dr REFSHAUGE: In general they are. It depends where they were raised. If they were raised from head office they would be kept with head office.

The Hon. Dr B. P. V. PEZZUTTI: I refer the Minister to Budget Paper No. 3, Volume 2, page 481, subprogram 49.1.3, Outpatient Services. Will he explain the 90 per cent blowout in employee-related operating expenses in 1997-98 from a budget of $196.69 million to $233.936 million?

Dr REFSHAUGE: We had a supplementary budgetary enhancement during the year, and that is reflected in that figure. That was announced at the time.

The Hon. Dr B. P. V. PEZZUTTI: Will the Minister explain where that came from, and how he got that budget enhancement?

Dr REFSHAUGE: The Government decided that it wanted to spend more money in health, and I was happy to receive it and provide it to the health list.

The Hon. Dr B. P. V. PEZZUTTI: How much was your budgetary allocation from consolidated revenue augmented?

Dr REFSHAUGE: I cannot remember at the moment. I will come back to you on that.

The Hon. Dr B. P. V. PEZZUTTI: Was it a large amount of money?

Dr REFSHAUGE: Yes.

The Hon. Dr B. P. V. PEZZUTTI: More than $100 million dollars?

Dr REFSHAUGE: I will come back to you with the exact details.

The Hon. Dr B. P. V. PEZZUTTI: Minister, given last year's difficulties with overdue creditors and your assurances at last year's estimates committee hearing that the problems had been addressed, will you detail the level of outstanding debts from 31 December 1997 and 31 March 1998?

Dr REFSHAUGE: I do not have the figure for 31 December 1997. My understanding is, as of when I checked it earlier this week, there are no debts outstanding over 45 days.

The Hon. Dr B. P. V. PEZZUTTI: There are no debts outstanding over 45 days?

Dr REFSHAUGE: That is my understanding. Some debts have been challenged by people who do not believe that the bill is correct. The budget supplementation was $134 million.

The Hon. Dr B. P. V. PEZZUTTI: In Volume 3 of the 1997 report to Parliament the Auditor-General identified some $40 million in loans from Treasury in 1996-97 to supplement the Health Department’s budgetary appropriation. Principally it repays the accumulation of accounts payable which had occurred in various area health services. The Auditor-General said this loan was earmarked to be repaid by the department in 1997-98. How much of this loan was repaid to Treasury in 1997-98, which area health services were unable to pay back in full or in part their loan component, when will those area health services be able to pay back their loan repayments and what penalties are there for late repayment?

Dr REFSHAUGE: It has all been paid back.

The Hon. Dr B. P. V. PEZZUTTI: It has all been paid back? Is the $134 million by way of a loan or grant from the Government?

Dr REFSHAUGE: It is recurrent funding.

The Hon. Dr B. P. V. PEZZUTTI: Was that $40 million taken out of the $134 million that you achieved in that way?

Dr REFSHAUGE: No, it was a loan and it was paid back before the extra $134 million was allocated.

The Hon. Dr B. P. V. PEZZUTTI: What financial measures has the Government taken to ensure that this is not repeated in 1998-99?

Dr REFSHAUGE: We obviously have a large system, with some 20 million occasions of service per year, and we face significant decreases in Federal funding and extra pressures as a result of the fall in private insurance. If we had not had a fall in private
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insurance, and if we did not have a Federal Government that cut our budget indiscriminately, without any warning, then we certainly would have no problem. While we have a Federal Government that arbitrarily decides to cut funding from us, while we have a Federal Government that cannot provide surety and continuity of the same level of private insurance, or at least compensate us for it, I cannot guarantee that Federal funding will come and, therefore, that puts extra pressure on us. We are doing significantly better than other institutions of that size that would be facing that type of massive, indiscriminate and arbitrary cuts.

The Hon. Dr B. P. V. PEZZUTTI: The Treasurer's Budget Speech indicates a continuing rise in Commonwealth Government allocations to you, not any cuts. Would you please explain where these cuts have come from?

Dr REFSHAUGE: The cuts have come from a number of areas. One is the cut in what is called the cost shifting penalty.

The Hon. Dr B. P. V. PEZZUTTI: A penalty, Minister; hardly a cut.

Dr REFSHAUGE: It is a cut that now totals more than $100 million. That is directly related, as the Federal Minister said, to the efforts of the former Government in New South Wales - that is, the former coalition Government - for cost shifting. The Federal Minister has said that at the time of imposing the cuts there was no evidence the Government here had done any cost shifting at all. In fact, he praised us for it and criticised the former coalition Government for cost shifting, for attempting to undermine the principles of the agreement in that sense, and imposing upon the people of New South Wales what he called a cost shifting penalty. There are also further cuts in regard to dental health. I am sure you are aware the Commonwealth decided to discontinue its dental health program and, as a result, cut our budget by an amount equal to the cost of the dental health program. That has been of the order of $94 million over three years.

Interestingly, my colleague the Minister for Health in Victoria is quite incensed about it. The Ministers for Health in Queensland - a National Party member until the recent election - in Western Australia and in South Australia have strongly criticised the Liberal-National Federal Government for what they believe to be unfair and uncaring cuts that have caused people with dental problems in their States to unnecessarily suffer, at the expense of Peter Costello developing a surplus. I admit that I find their logic to be pretty spot on. I agree with Mike Horan, Pete McKay, Rob Knowles, Dean Brown, Kevin Prince and Denis Burke in their condemnation of John Howard, Michael Wooldridge and Peter Costello for making such a very poor decision on policy and affecting so many people.

The Hon. Dr B. P. V. PEZZUTTI: I refer to Budget Paper No. 3, Volume 2, page 479, subprogram 49.1.1, Primary and Community Based Services, line item "Grants and subsidies, National Campaign Against Drug Abuse". Why was the 1997-98 amount underspent by $237,000? Why has the 1998-99 amount been cut to $3.3 million, which is below the 1995-96 funding? Will the Minister guarantee that the $3.3 million, small as it is, is spent entirely, as the previous two allocations were equally underspent?

Dr REFSHAUGE: One of the problems we have with a number of Commonwealth programs is that the money arrives late. As a result, the Commonwealth Government has agreed, because we asked it, to allow us to roll over funding that has not been spent that year.

The Hon. Dr B. P. V. PEZZUTTI: You have underspent three years in a row.

Dr REFSHAUGE: Maybe we should be talking to the Federal Government. The honourable member has to realise that the Federal Government decided to make a productivity cut to its SPPs of 5 per cent, which it decided the States should bear rather than it making that saving.

The Hon. Dr B. P. V. PEZZUTTI: You keep mentioning these Commonwealth Government cuts and you say there can be rollovers, why have you underspent three years in a row in this very important area of health care?

Dr REFSHAUGE: This is a joint program with the Commonwealth Government. I am not criticising the Federal Government for delays in its allocations to us and agreements with us, but in many cases it is directly a result of its and its bureaucracy's ability to get the funding out to be able to be spent.

The Hon. Dr B. P. V. PEZZUTTI: I refer the Minister to Budget Paper No. 3, Volume 2, Page 479, subprogram 49.1.1, Primary and Community Based Services; to page 486, subprogram 49.2.2, Overnight Acute Inpatient Services; to page 495, subprogram 49.6.1, Teaching and Research. All three programs have the amount budgeted for grants and subsidies to third schedule hospitals underspent in 1997-98 financial year. Will the Minister detail where the underspending occurred?


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Dr REFSHAUGE: There has not been any concern raised by those who would be the recipients. I will take that question on notice and get an answer for the honourable member.

The Hon. Dr B. P. V. PEZZUTTI: Further to that, all three programs have experienced a reduction in the amount budgeted for in 1998-99 compared with the budget announced in 1997-98. Could you please explain why these third schedule hospitals have received less than State Government grants and subsidies?

Dr REFSHAUGE: Some of them have been changed. My understanding is that one may relate to Port Macquarie Base Hospital, but I do not know the details. I will take the question on notice and forward the details to the honourable member.

The Hon. Dr B. P. V. PEZZUTTI: I refer the Minister to Budget Paper No. 3, Volume 2, page 486, subprogram 49.2.2, Overnight Acute Inpatient Services, line item "Isolated Patients' Travel and Accommodation Assistance Scheme". What is the current average rate of payment for IPTAAS claims from the time claims are lodged to the time the cheques are sent?

Dr REFSHAUGE: They are done at the local level. I do not know.

The Hon. Dr B. P. V. PEZZUTTI: Will the Minister find out?

Dr REFSHAUGE: It would take a significant amount of public time. If it is reasonable, I will certainly find out.

The Hon. Dr B. P. V. PEZZUTTI: It is a source of considerable problems in rural New South Wales, as the Minister would be aware, and those people spend a lot of time waiting.

Dr REFSHAUGE: If you would prefer people to spend their time getting an average rather than paying it, you can certainly argue that case.

The Hon. Dr B. P. V. PEZZUTTI: What amount is currently owed to patients or guardians for more than 45 days? How long is the time taken to process a payment? That is a fairly reasonable straightforward question. If I come up and ask for a payment under IPTAAS -

Dr REFSHAUGE: If you are asking for the average over the last year that would involve checking every payment.

The Hon. Dr B. P. V. PEZZUTTI: How long does it take at the moment?

Dr REFSHAUGE: I could find that out for you. I understand it is -

The Hon. Dr B. P. V. PEZZUTTI: And how many people did in fact receive IPTAAS payments last year?

Dr REFSHAUGE: I do not know.

The Hon. Dr B. P. V. PEZZUTTI: I refer to Budget Paper No. 3, Volume 2, page 487, subprogram 49.2.3, Same Day Acute Inpatient Services. Given that same-day admitted patients as a proportion of the total of acute admitted inpatient is estimated to be 34 per cent in 1998-99, which is less than the proportion of 34.6 per cent in 1995-96, how do you propose to achieve your pre-election promise of having 60 per cent of operations done on a same-day basis?

Dr REFSHAUGE: The commitment was to increase the number of operations to 50 per cent, not 60 per cent. In most areas that has been achieved, and I would expect that it would increase.

The Hon. Dr B. P. V. PEZZUTTI: The average is now lower than it was in 1995-96.

Dr REFSHAUGE: That is talking about operations in hospitals.

The Hon. Dr B. P. V. PEZZUTTI: No.

Dr REFSHAUGE: But it still is in a hospital setting. If you are referring to surgery, it is not just performed in a hospital setting. It can be done in other clinics.

The Hon. Dr B. P. V. PEZZUTTI: What were the results of the feasibility study into a drug and alcohol detoxification unit in Lismore, scheduled for completion in September 1997? What amount of money has been allocated for this project in 1998-99, and when will it open?

Dr REFSHAUGE: My understanding is that the feasibility study is still progressing. When we have that finalised we will be able to ensure rapid progress with the building and opening of it.

The Hon. Dr B. P. V. PEZZUTTI: Given that the chief executive officer of the Northern Rivers Area Health Service has refused to rule out cuts to the Tweed Heads, Murwillumbah and Lismore hospitals in the 1998-99 financial year, will the Minister give a
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guarantee that services of staff and operating theatre hours will not be reduced in any of these hospitals in 1998-99?

Dr REFSHAUGE: Much has been made by the honourable member and the Opposition about the budget for the area health services. I think it would be enlightening for the members of the Committee to hear what we have achieved in the Northern Rivers Area Health Service since coming to Government. In 1994-95, the coalition's last year in Government, the budget for the Northern Rivers Area Health Service, which was at that stage a number of districts but now with combined boundaries is able to be identified, was $134 million. Under the Labor Government the Northern Rivers Area Health Service budget increased in 1995-96 to $141 million and in 1996-97 to $151 million.

The Hon. Dr B. P. V. PEZZUTTI: So has the debt.

Dr REFSHAUGE: And so too has the fallout of private health insurance, which your colleagues in Canberra are unable to do anything about along with the major cuts to the dental program and cost shifting. The 1997-98 budget was $162 million, almost $30 million more for that area health service than was provided by the coalition Government. Certainly in that time inflation has not been running rampant. It is not as though that would have been gobbled up by inflation. That is an absolutely massive increase. The increased budget has been able to provide for a range of expanded services and also to cope, to some degree, with the drop out of private insurance, the cuts that the Federal Government has made to us - the specific cuts to programs such as dental health, women's health - and the 5 per cent cut to the special purpose payments.

It is a great tribute to the Carr Government that it has been able to increase funding for the Northern Rivers Area Health Service by almost $30 million in four years. It would be difficult to find any area of similar size where the former coalition Government could claim to be able to provide anywhere near that increase in funding. It is a great credit to those who are working very hard in the health system that they are using it wisely; it is a great credit to those who are helping us plan better services that they are prepared to look at imaginative ways of improving the range of services and looking at how they can maximise for the patients of the area the use of that money. I am also very proud that in three years we have been able to have such a significant increase not only in the Northern Rivers Area Health Service but in all area health services.

The Hon. HELEN SHAM-HO: I refer to Budget Paper No. 3, Volume 2, page 480, subprogram 49.1.2, Aboriginal Health Services. The operating statement indicates that the Aboriginal health budget was underspent by $3.335 million, of which grants and subsidies to voluntary organisations were underspent by $1.168 million. Which voluntary organisations had their funding underspent and which other services had their funding underspent?

Dr REFSHAUGE: None of the voluntary agencies, to my knowledge, underspent. It may be not of large consequence, but certainly if there are any that vary from that I will let the Committee know. It is important in the area of Aboriginal health that we do not miss out on the important part of program development, which is consultation with the community. Often a program is delayed while the community assesses it, develops their approach and informs us of the direction in which they want to go, which may have been different or may have been the same as the direction we intended to go.

We have a new policy, which is that there is a partnership with the Aboriginal Health Resources Co-operative, which is the peak organisation of the Aboriginal medical services in this State, with the Health Department. Part of that partnership agreement is that we must discuss issues such as funding, the parameters of those issues, and policy with the AHRC and get its agreement before we move on them. That sometimes means that things will be delayed in establishing them while the AHRC goes through its internal processes of consultation and discussion with its communities.

The Hon. Dr B. P. V. PEZZUTTI: Are you saying that these budget papers continue to be incorrect?

Dr REFSHAUGE: No, I am saying that they are correct, but the important thing is that we have processes that I am not prepared - and I hope that the honourable member is not arguing that I should be prepared - to undermine for your value, against the interests of the Aboriginal community. I will not do it.

[Time expired.]

The Hon. A. B. KELLY: Minister, how does the level of State funding for health detailed in Budget Paper No. 2, page 4-152, compare with that received from the Commonwealth?

Dr REFSHAUGE: Over four budgets the Carr Government has been able to deliver a record $1.3
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billion in additional funding to the public health system, which is a massive increase. In contrast, the Howard Government has been cutting funding to health in each of its budgets. The day after the Federal budget was released the current Federal Minister for Health, Dr Michael Wooldridge, boasted:

It is unpopular but it is a fact we have been very good at cost containment. The increase in health funding over and above CPI has been contained from 5 per cent down to 2.6 per cent annually. It has declined as a proportion of government outlays in GDP.

He went on to tell his audience that the Federal expenditure on health in terms of GDP is now the third lowest in the western world. This is the Federal Government that boasts that it is spending the third lowest on health in the western world. It is a boast that is quite at odds with the community's expectations. The Commonwealth Minister has been a complete failure in his negotiations with the States for the new Medicare agreement. Not one State has signed up.

The Australian Capital Territory and Queensland have agreed in principle but have not signed up. Instead of finding a way out of the current impasse, the Federal Minister has criticised the States and Territories for allegedly pulling money out of health over the life of the current Medicare agreement while claiming that the Commonwealth has increased funding. But I am pleased to be able to advise members of the Committee that this myth has been rebutted by Access Economics. Access Economics was appointed by the Western Australian health department with the support of the other States and the Northern Territory to report on the comparative effort of health financing by the Commonwealth compared with the States. This independent agency made the following findings:

1. It appears that in the recent Medicare agreements the Commonwealth's offer has provided front end financial carrots to induce the States to enter a five-year agreement and in the process boosted, at least initially, the Commonwealth's share of hospital funding, but the escalation formula for the grants has left much of the financial risk, the risk of growth and per capita utilisation at the States' doorstep.

2. It seems an inevitable outcome that the escalation of the base grant by price and population leaves the States with an increased financial burden towards the end of the five-year periods, and this generates demands for a higher base amount to kick off the next agreement.

3. Following the introduction of the first Medicare agreement in 1984 the State governments were funding around 45.3 per cent of public hospital expenditure. The Commonwealth was funding 54.7 per cent. In 1997-98 it estimates that the States' share would be 51.2 per cent and the Commonwealth's share 48.8 per cent.

The Hon. Dr B. P. V. PEZZUTTI: That would include private income.

Dr REFSHAUGE: This is Access Economics' report. So the Commonwealth Government has reduced its -

The Hon. Dr B. P. V. PEZZUTTI: That would include patient fees.

Dr REFSHAUGE: The report stated that bonus pool payments should be increased for the number of public patients and found as follows:

The Commonwealth's effort in financing public hospitals should have increased faster than the State's efforts and the bonus pool represents a structural change in the agreements with the Commonwealth effectively committing itself to picking up a larger share of the tab. Since 1993-94 State spending from own source revenue on both hospital and total health services has increased strongly in real terms and at a faster rate than the Commonwealth.

[Time expired.]

The Hon. A. B. KELLY: I am very interested in the answers to some of these questions for a hearing the Committee is conducting. If the Minister does not complete his answers because of the time restriction, will he provide the Committee with the full answer on notice? The next question relates to Aboriginal communities. What initiatives has the Government developed to improve infrastructure services in Aboriginal communities, as detailed in Budget Paper No. 2, page 4-153?

Dr REFSHAUGE: The Government has announced, and is very proud to have done so, an Aboriginal community development program. It is in response to the need for improving living conditions and infrastructure needs in many Aboriginal communities. This program is a new capital construction and upgrade program, which will raise health and living standards of communities with urgent environmental health needs. The program will be targeted with a high level of identified housing, water, sewerage, sporting, recreation and cultural infrastructure that are in need in a number of Aboriginal communities. A total of $200,000 million in funding has been allocated already to the Department of Aboriginal Affairs over seven years, commencing this financial year, 1998-99. An amount of $10 million has been allocated already in the first year.

The program will target a number of key areas which impact on health and living conditions, such as housing construction and repairs, water supply, sewerage disposal, dust control, internal roads, rubbish
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removal, priority recreational and community facilities, and preservation of significant cultural sites. The program will also prioritise the municipal infrastructure, such as footpaths, kerbing and guttering, safety lighting and security fencing. The initial program allocation of $10 million in year one will target high-level, urgent water and sewerage works. During this year the Department of Aboriginal Affairs, in conjunction with the Department of Public Works, will develop a six-year capital program. This will involve the identification of priority communities, on-site infrastructure assessments, appointment of a program manager and formal approval of the program works.

Over the past three years, the Government has piloted the Aboriginal environmental health infrastructure program. It was piloted in Muli Muli, Dareton and Wilcannia, and it has provided a framework for the Aboriginal community development program. The Aboriginal environmental health infrastructure program has shown us key principles for success when working with Aboriginal communities to improve the infrastructure, and these will certainly provide the framework for the new program. The Aboriginal community development program will recognise the need to increase the involvement of the Aboriginal community in the provision of skills and labour in capital works programs. It will be done by maximising training and employment opportunities, which are in accord with the state of needs and aspirations in assisting Aboriginal communities. The program will consult with Aboriginal people in the design and construction of their housing by adherence to an open and participative consultative process in the development of individual projects based on the principles of self-determination and self-management.

The Government further recognises the need for sustainability in all infrastructure, including the maintenance of capital infrastructure, because it has seen that past governments have not provided a sustainable focus on their activities with Aboriginal infrastructure. As a result infrastructure has not been longlasting and living conditions have not reached the standards comparable generally to the non-Aboriginal community. The program recognises that sustainability must be undertaken by the communities. Therefore, a large component of the program will address the employment, training and management needs of the community. It is a program we will all be keen to support and hopefully significant improvements will be shown in the not too distant future.

The Hon. A. B. KELLY: I would like some more details. As a former general manager of an area with an Aboriginal community, I understand the reason that community would want the exclusive use of that money. The Government has achieved a good result. I turn now to other Aboriginal matters. Will the Minister explain the current budget level in Aboriginal affairs, given the decrease in the payments to the New South Wales Aboriginal Land Council?

Dr REFSHAUGE: Under the Aboriginal Land Rights Act 1983 a statutory amount equal to 7.5 per cent of land tax is paid to the New South Wales Aboriginal Land Council and the provision of land tax payments was to continue until the end of 1998. The last land tax payment is due in January 1999 and following this period the land council system will be self-funding. The major component of the capital program of the Department of Aboriginal Affairs is the payment of land tax to the New South Wales Aboriginal Land Council. The 1998-99 funding estimate to the land council is some $13 million. This represents the final payment. The funds are allocated by Treasury to the Department of Aboriginal Affairs which provides them to the Aboriginal Land Council for the operations of the land council system. As a result, budget allocations to Aboriginal affairs will appear to decrease due to the statutory cessation of this funding.

To date the New South Wales Aboriginal Land Council has received more than $500 million in land tax allocations, the purpose of which is to compensate Aboriginal people for dispossession from their lands. The Aboriginal Lands Rights Act acknowledges Aboriginal people's prior ownership of land in New South Wales and the cultural and spiritual significance of land to them. The Act also acknowledges that land was taken from Aboriginal people without compensation. Under the Act 50 per cent of the land tax funds allocated to the New South Wales Aboriginal Land Council are to be invested and moneys contained in the investment fund and interest accruing from it may not be dispersed. However, interest accruing after 31 December 1998, when the land tax allocation ceases, may be used to fund the operations of land councils. Whilst the land tax allocation ceases at the end of 1998, land councils will continue to be regulated under the Aboriginal Land Rights Act.

One of the most significant achievements of the Aboriginal Land Rights Act has been the development of the land council structure. The land council structure provides a representative body for Aboriginal people in New South Wales and provides them with an appropriate forum to ensure that their interests are considered at local, regional and State level. At the local level the local Aboriginal land councils play an important role in facilitating communication between the Aboriginal community and the local government, between developers and the community and between
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other community groups and the local Aboriginal community. They also provide important services in some instances, such as housing and community development programs. At a State level the New South Wales Aboriginal Land Council was instrumental in facilitating native title claims and ensuring that Aboriginal people's views were heard within Government. In 1999 the land council structure will be fully self-funding.

The Hon. A. B. KELLY: Minister, how is the Government addressing the issues raised by ICAC and the Auditor-General in relation to the operation of the Aboriginal land taxes?

Dr REFSHAUGE: ICAC projects on the Aboriginal Land Council resulted from a relatively high number of complaints received by ICAC from Aboriginal people about land councils. The focus of the corruption prevention project recommendation is on preventing opportunities for corruption in land councils. In New South Wales the Aboriginal Land Council has endorsed ICAC's recommendation and has undertaken to implement it. In this respect some progress has already been made, for example, the council has prepared a code of conduct for members. It is important to note that the latest New South Wales Aboriginal Land Council's audited report was an unqualified report. It is the third unqualified report since 1990. This is a commendable performance and augurs well for the New South Wales Aboriginal Land Council's ability to perform its statutory function.

The Department of Aboriginal Affairs is also working with the New South Wales Aboriginal Land Council to improve its ability to produce annual reports. In addition, the Government has increased resources to the registrar of the Aboriginal Land Rights Act to provide increased assistance to local Aboriginal land councils. The Government is also aware of some problems with the operation of the land council system. For this reason, in response to ICAC's discussion paper on land councils, the review of the Aboriginal Land Rights Act was announced. Amendments made to the Act followed a review by the Greiner Government in 1990 to limit the role of regional Aboriginal land councils. The amendments also expanded the functions of the New South Wales Aboriginal Land Council and strengthened the Act's financial provisions. As shown by ICAC, these changes have been largely ineffective. The current review of the Act is essential for the implementation of ICAC's recommendations and to also provide an opportunity to deal with the concerns expressed by the Auditor-General.

The aim of the review is to consolidate and improve the achievements of the land rights system. The first stage of the review will include the preparation of a discussion paper taking into account submissions, research and ICAC's recommendations. The second stage will involve a period of consultation. The review will go beyond the scope of the work done by ICAC and will consider issues such as the interrelationship between land rights and native title, the functions of land councils, alternative structures and possible international models for reform. The review will not include land rights or those provisions of the Act which deal with hunting and gathering, and mining rights. Processes impacting on these issues will be dealt with as part of the administrative review by their own relevant agencies. A steering committee, comprising the Department of Aboriginal Affairs, the New South Wales Aboriginal Land Council, the New South Wales Law Reform Commission, the registrar of the Aboriginal Land Rights Act and the Premier's Department, has been established to oversee the review. The Government expects to place advertisements seeking submissions from interested parties in July.

The Hon. A. B. KELLY: I refer to Budget Paper No. 4, page 56, line item "Central Coast Area Health Service Strategy". What steps has the Government taken to further enhance the health care services available on the central coast?

Dr REFSHAUGE: The Government has made a major commitment to improving health services for the people on the central coast. We are delivering on that important promise with the announcement this year of another $11.6 million for new capital works for the central coast. That funding is a top priority for central coast families. The $6.4 million commitment to build community health centres at Erina and Tuggerah is very welcome and, in fact, has had significant community support since the announcement. Since coming to office we have stressed that high-quality community health services are vital to protect the long-term health and wellbeing of children and families. We have made community health a key priority to emphasise the importance of health promotion and early intervention to prevent illness and disease. Nowhere are these services more important than in fast growing areas such as the central coast.

Significant new investment for 1998-1999 really showed our commitment to those families and their needs for community health centres at Erina and Tuggerah. Families will enjoy easy access to a comprehensive range of health care services in a comfortable and caring, purpose-built environment of local community health centres. Families are inconvenienced in travelling out of their immediate area for treatment and support. Improving community health remains a strong and enduring priority of the
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Government. We are determined to safeguard local communities from the fall-out of John Howard's damaging cuts to health services in Australia. We are determined to deliver better services to the areas disadvantaged by the previous coalition Government and we are determined to put families first. The greater investment in community health means we can protect families at the grass roots level, and improved early detection and better health promotion certainly will pay dividends in the medium to long term.

The $6 million initiative of the new community health centres builds on the $3.2 million commitment we made last year to the new community health centres at Lakehaven and Long Jetty, expanding the network of community health services and promising new benefits to families in the region. Families on the central coast will also benefit from the construction of a $5.2 million day surgery unit at Wyong. The new initiative in the 1998-1999 budget expanding day service facilities means easy access to treatment and faster recovery for more patients. This $5.2 million initiative will deliver shorter waiting times for surgery for thousands of central coast patients and their families.

Between 1993-1994 and 1996-1997 same-day surgery procedures on the central coast increased by almost 40 per cent. With the construction of a new day surgery unit at Wyong we can build on that achievement and put more patients on the road to recovery sooner. The central coast is one of the faster growing areas of the State and remains a key priority for the Government. The important investment in day surgery acknowledges that population growth and also will deliver significantly improved services to the Sydney to Wyong region. The Carr budget has delivered increased spending in New South Wales, despite Federal Government cuts and policy backflips, particularly for aged care. I am delighted that the families of the central coast will reap the benefits of record health spending from the State Government. We are maintaining a strong commitment to bring more and better services to a region that was for too long disadvantaged by the long-term underfunding of the Greiner and Fahey governments.

The Hon. A. B. KELLY: I refer to Budget Paper No. 4, page 56, line item "Illawarra Area Health Service Strategy Stage 2". What improvements to hospital services have been approved for families in the Illawarra in the 1998-99 budget?

Dr REFSHAUGE: The Government's 1998-99 budget delivers a $62.5 million boost to Illawarra health services putting families of that region first. Wollongong and Shoalhaven families are a clear priority in this year's budget, which makes a major commitment to new health capital works in the Illawarra. The $62.5 million investment represents a clear win to health care in the Illawarra, a great win for the families throughout the length and breadth of that very important region. We will secure new benefits for local patients and their families and build on the work that has been already done to bring better health care and funding to this growing region. This commitment includes funding for stage two of a major redevelopment of the Illawarra Regional Hospital, replacing the outdated Hickman House and refurbishing the clinical services building. The new works will provide state-of-the-art treatment for patients and their families, as well as a comfortable, efficient working environment for staff.

Under this $62.5 million program a comprehensive range of diagnostic treatment services will be upgraded, including a new obstetrics ward, a neonatal intensive care unit and birthing suites, cardiac and gastroenterological inpatient services, and cardio and neurological diagnostic services. There will be new academic teaching facilities, lecture theatres, offices and research facilities. The upgrading of the clinical services block will include car parking and a new dialysis centre. The funding also provides for the project definition planning at Shoalhaven District Memorial Hospital and the Illawarra area health asset strategy. We are determined to deliver further resources and improve hospital facilities for Shoalhaven patients.

Preliminary planning to determine the best course for future work will be part of that agenda. Proposals are now being invited from suitably qualified consultants to undertake planning and implementation of the strategy for both Wollongong and Shoalhaven. Carr budgets have increased each year which underscores the commitment we made to the Illawarra and families to right the imbalance caused by long-term coalition underfunding of the area. It builds on the work we have already done for this growing area, including upgrading the Wollongong clinical services block, which you might remember was a promise that the former Government ratted on -

The Hon. Dr B. P. V. PEZZUTTI: No, that the former Government proceeded on.

Dr REFSHAUGE: - and left a hole in the ground.

The Hon. Dr B. P. V. PEZZUTTI: The former Government proceeded on it, as you know.

Dr REFSHAUGE: It left a hole in the ground, and we had to come in.

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The Hon. Dr B. P. V. PEZZUTTI: Madam Chair, I find that answer by the Minister absolutely offensive and inaccurate. I would like it withdrawn.

Dr REFSHAUGE: We had to come in.

The Hon. Dr B. P. V. PEZZUTTI: On a point of order. That comment is inaccurate and offensive to me. I would like it withdrawn.

CHAIR: I did not hear the comment.

The Hon. Dr B. P. V. PEZZUTTI: He said the previous Government ratted on the Illawarra. I find that offensive and I want it withdrawn.

Dr REFSHAUGE: I am happy to withdraw it.

CHAIR: Thank you.

Dr REFSHAUGE: I am happy to withdraw that comment. I will say instead that the former Government, having said it would build the clinical services block, decided not to progress.

The Hon. Dr B. P. V. PEZZUTTI: Madam Chair, I find that highly offensive and inaccurate. I would like it withdrawn.

CHAIR: It is not personally offensive.

The Hon. Dr B. P. V. PEZZUTTI: I find it personally offensive. Given that I was the parliamentary secretary for health at the time, I am aware of what happened. The Minister is attacking me in my role.

Dr REFSHAUGE: There is a hole in the ground. We have pictures of it. We can prove it. If you do not like it, go and see the pictures.

CHAIR: There is no point of order. I entreat the member and the Minister to act with some degree of civility so that we can get through this hearing.

Dr REFSHAUGE: The Government will be reopening Kiama District Hospital, another hospital that the coalition promised it would never close when it was in opposition, and then closed when it took office. The Carr Labor Government will reopen it very soon. That valuable facility was closed by the former coalition Government.

[Time expired.]

The Hon. A. B. KELLY: Minister, in light of the delays during that answer, will you take the balance of it on notice? Will the Minister detail improvements to the New South Wales Ambulance Service, referred to in Budget Paper No. 4 at page 56?

Dr REFSHAUGE: I am pleased with the New South Wales Ambulance Service. It is interesting to note that there were fewer ambulance officers at the end of the coalition Government's term than at the beginning. New South Wales ambulance officers provide immediate front-line care. That front-line care is so important to change the course of an accident, injury, illness, or somebody's life. On average, ambulance officers are sent out to care for patients 2,000 times on any one day; it is a massive enterprise. The Carr Government, in acknowledging its work, has committed $18.3 million to enhance the Ambulance Service.

The increased funding will go towards replacing the older F-series ambulances with the more modern GC-series vehicles; allow for construction of new ambulance stations at Bringelly, South West Rocks, Tanilba Bay and Morisset; refurbish a number of existing ambulance stations; and upgrade medical equipment carried by ambulances. The capital enhancement will allow an ambulance officer to provide even faster care to patients in New South Wales. A new fleet, new ambulance stations and new equipment will make their very difficult job that little bit easier. The Government is committed to the work of ambulance staff. Their work is vital to providing care for patients and families of New South Wales.

The Hon. A. B. KELLY: Will the Minister detail significant capital works projects being undertaken in rural New South Wales, as detailed in Budget Paper No. 4?

Dr REFSHAUGE: The Government has shown a long-term commitment to country New South Wales, and this budget continues that commitment. The capital works that you highlighted are part of that commitment, and we are determined to secure a better health future for families and communities in rural and regional New South Wales. Since coming to office the Carr Government has embarked on a massive capital program, particularly in rural New South Wales, including the construction of new hospitals and the redevelopment of existing facilities. We have invested more than $170 million in rural hospital capital works. Since 1995 these major capital works include many new or greatly enhanced hospitals for the people of Broken Hill, West Wyalong, Taree, the Tweed, Coffs Harbour, Lithgow, Ballina, Cowra, Grafton, Mudgee, Boorowa and Dubbo. The list goes on.

On Friday the Premier and I will have the great pleasure of reopening Kiama District Hospital. As I
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mentioned earlier, it is one of the 30 hospitals that were closed, wound down or privatised by the former coalition Government. Despite the coalition Opposition promising never to close Kiama hospital, it did so when it was in office. The Carr Labor Government is reopening that hospital. Significant other capital works in rural New South Wales being undertaken include the $18 million Dubbo Base Hospital redevelopment; $5 million at Armidale; more than $32 million for the Broken Hill Base Hospital redevelopment, which is a very interesting design and if people could have a look at it would be worthwhile examining; more than $53 million to Coffs Harbour and District Hospital. An amount of 2.5 million for the Dubbo multipurpose service; $26.5 million for Lithgow; the $26 million strategy at Manning Base Hospital; Mudgee District Hospital upgrade of more than $2 million; Oberon multipurpose service of more than $2.5 million; Trundle multipurpose service; Tumbarumba multipurpose service; stage three of Tweed Heads over $31 million; Warren MPS, almost $3 million; West Wyalong, over $6 million; Wilcannia, $3 million; Grenfell, $3 million; Trangie MPS, over $1 million, and Lithgow Community Health Centre, $1.5 million. On top of that, rural health funding under the Carr Government has increased by 25 per cent. That is a massive increase - more than $170 million in rural capital works. We are performing more than 40 per cent same-day surgery in rural hospitals. We are performing 16 per cent more operations in rural hospitals than when we came to office. That is an enormous effort and the staff should be congratulated on the work they are doing, including the Hon. Dr B. P. V. Pezzutti as an anaesthetist occasionally at Lismore. In addition, I refer to the $2 million rural work force strategy to build on ideas that are coming to us to develop -

[Time expired.]

CHAIR: The Government's 30 minutes question time has expired.

The Hon. A. B. KELLY: Well, it was not quite 30 minutes because of the significant interruptions, so I will put some questions on notice.

CHAIR: The honourable member is permitted to put questions on notice.

The Hon. ELISABETH KIRKBY: I refer the Minister to page 56 of Budget Paper No. 4. My question is related to the previous question asked by the Hon. A. B. Kelly. I see that the Government has allocated $3 million on the redevelopment of Armidale Hospital and intends to spend $1 million rehabilitating the emergency department at Inverell Hospital, of which $173,000 will be spent in 1998-99. What is your intention in relation to the hospital at Taree? According to this budget paper, $8 million has been allocated for what is known as the lower north coast strategy. What will that strategy involve? Will Taree Hospital remain a level 4 hospital?

[Time expired.]

Dr REFSHAUGE: Could the honourable member repeat the last part of the question?

The Hon. ELISABETH KIRKBY: People are concerned that the status of the Taree Hospital is to be downgraded. There is nothing in the budget papers to suggest that money will be spent at Taree Hospital, but $8 million has been allocated for the lower north coast strategy. What does that mean?

Dr REFSHAUGE: The lower north coast strategy is the redevelopment of the Manning Base Hospital, which is part of the confusion. The hospital at Taree is called the Manning Base Hospital. It is on the lower north coast.

The Hon. ELISABETH KIRKBY: Will the total $8 million go to the Manning Base Hospital?

Dr REFSHAUGE: It is for the redevelopment of Manning Base Hospital, incorporating the theatres and recovery, the day-only service, emergency, intensive care and coronary care; the refurbishment of other areas of the existing hospital, such as physiotherapy, paediatrics, surgical and medical inpatient accommodation; and the relocation of community health services on site and their accommodation upgrade. It has been approved by Treasury; there is no indication of any delay in completion.

The Hon. ELISABETH KIRKBY: In your reply to the Hon. A. B. Kelly you mentioned a great number of multipurpose service centres that ought to be funded by your Government. It has also been stated that no area would have an MPS unless it was the wish of the local community. Of all the centres you mentioned in your reply, can we be assured that they have all agreed to the establishment of an MPS?

Dr REFSHAUGE: Yes, I am advised that they have agreed; and another one was strongly recommended, but the community decided against it and so it was not proceeded with. The other day a man told me that he was so pleased with the multipurpose centre of which he is the chair of the board that he has encouraged and enthused anybody considering such a centre to come and visit. So a number are up and going. They are very keen to display what can be done. People often have a misconception about multipurpose centres and seeing
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them on the ground working can be valuable for a community contemplating such a centre.

The Hon. ELISABETH KIRKBY: On page 57 of the same budget paper, $11.3 million has been allocated for an information management and telecommunications strategy. Will the Minister explain how that money will be spent?

Dr REFSHAUGE: It is an information management and technology strategy. The cancer registry system provides for replacement of the outdated computer systems and the clerical-based paper systems. The new system is based on an open system and also on departmental standards to make cancer information available in different reporting formats within 12 months from the time it was gathered. Many reports will be made available on the Internet, in line with the Government's connect New South Wales strategy. That implementation provides the capacity for the registry to revise the business processes, and enhance its client service focus and approach to management and dissemination of population-based cancer information.

There is also the community health information development at a total cost of some $23 million for development and implementation of specialised clinical applications to support care providers by giving community health workers across the State access to office automation tools to roll out of the office productivity technology. The health information exchange, at a total cost of $11.5 million, is to establish reporting databases at area and departmental level to support outcome decision making in health service delivery for service managers and clinicians. A $10.5 million computerised dispatch system for the Ambulance Service will greatly improve timeliness and efficiency. The system allows the Ambulance Service to handle that ever-increasing volume of requests, while also maintaining and improving response times and service standards. Those are the major aspects of it.

The Hon. ELISABETH KIRKBY: I refer to Budget Paper No. 2, table 3.6, under the heading "Commonwealth Grants". The table shows that the hospital funding grant from the Commonwealth Government has been increased by 11 per cent to $1.7 billion. Will the Minister tell the Committee how this enhanced funding will be used?

Dr REFSHAUGE: My answer to this question is the same as my answer to an earlier question that referred to the comparison between State funding and Commonwealth funding. As you probably remember, the State's contribution to health funding has significantly increased over the time of the Medicare agreement, particularly in the last three years or so. In the first year one could argue that there was actually a cut in State funding to health by the former coalition Government. It argued in its defence that at the same time it cut its health funding and the Federal Government increased health funding there was a cut also in financial systems grants to the States. The Liberal Opposition has never argued that, which is a reasonable case to put. The Liberal Government argued that it cut funding of its own volition.

The reality is, though, with the increase in the age of the population, technology, the cost of drugs and new services being provided, the cost of health care is significantly increasing. As a result, factors have been put in to increase funding at the Commonwealth level, such as the last Medicare agreement, but with those factors included, funding has increased for every fall of 2 per cent in private health insurance. We reached an agreement with Carmen Lawrence that there would be no cost shifting penalty and there would be a wind up of the 2 per cent issue. The Victorian health Minister, Rob Knowles, is on record as saying it actually happened when I was at one of the earlier conferences of health Ministers. Since the change of government, the Federal Government has reneged on both of those issues. There should have been an increase in line with all of those things, including the fall in private health insurance, but it has not come through. In effect, with the ageing of the population, the increase in population, technology, drugs and those pressures, we have been picking up the slack at the State level because of a lack of Commonwealth commitment.

The Hon. ELISABETH KIRKBY: That same table also shows a funding increase of 11 per cent for highly specialised drugs. Are you able to say which drugs these are and which patients will benefit? Is that money to be spent at your discretion, or is it tied to certain types of drugs for specific medical conditions?

Dr REFSHAUGE: It is tied by the Federal Government to specific drugs for specific conditions, and the amount of money actually spent depends on the number of those drugs being prescribed. In that sense, the responsibility has been accepted by the Federal Government. If anything, we work as a post office, passing on the funding to the hospitals where the costs are generated. If you want to know which drugs they are, and there is quite a range of them, we would be pleased to provide you with a list on notice.

The Hon. ELISABETH KIRKBY: It would be helpful if the Committee could have those details.

Dr REFSHAUGE: From memory, some drugs in relation to HIV-AIDS are funded differently, not through this process.

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The Hon. ELISABETH KIRKBY: That was what I was leading to. The table also shows funding for drugs to combat AIDS and funding for essential vaccines. I assume that essential vaccines will not be covered by this particular grant and nor will drugs for AIDS. Is it possible for you to say whether there will be any additional funding through those particular grants for people who have contracted hepatitis C?

Dr REFSHAUGE: I think there is still negotiation with the Commonwealth in regard to that. But funding for HIV-AIDS, as you point out, is separate. The high-cost drugs are for particular conditions, and funding would be useful for recommended drugs. From our point of view, those drugs are prescribed on a cost recovery basis. The Federal Government reimburses and we reimburse the hospitals. There is certainly ongoing negotiation between the Federal Government and all States now - certainly it was only New South Wales originally - about treatment for hepatitis C, what is available, what should be supported and how it should be funded.

The Hon. ELISABETH KIRKBY: Again, referring to the same table, why has funding for breast cancer been revised downwards from $15 million to $12 million? Does any of this money go to the New South Wales Cancer Council?

Dr REFSHAUGE: A number of organisations are involved in breast screening. My understanding is that the Cancer Council has a program and would be in receipt of some of that funding. I am informed that the Federal Government decided to cut $4 million from the special purpose payments and that is probably the reason.

The Hon. ELISABETH KIRKBY: I asked that question because later in this section of the budget papers, on page 157, it says that the council has estimated total expenses of $23 million, which are primarily funded by donations from the community and grants. I wondered if one of those grants was a State grant, but initially from the Commonwealth Government?

Dr REFSHAUGE: The breast screening program is a joint State and Commonwealth funded program, so my understanding is that there is funding from both of us in the sense that if there is State funding there would be commensurate Commonwealth funding. I am reminded that the Federal Government did cut funding to women's health as well.

The Hon. ELISABETH KIRKBY: I note also that there is a considerable 9 per cent cut in funding from the Commonwealth Government for drug education campaigns. I realise that the Federal Government operates on a zero tolerance policy, but there is also the problem of the legal, deadly drug, tobacco. How will this cut assist to continue education so far as the abuse of tobacco is concerned?

Dr REFSHAUGE: With difficulty, as you pointed out. If the Federal Government unilaterally decides to cut a program it is difficult for us to do anything except to effectively pass on that cut. I take your point that the Federal Government has a different approach announced by its Prime Minister to that of its health Minister. The Victorian Government is concerned to try to help meld those two approaches to get some sense from the Federal Government's policy backflip and change of attitude or dual attitude. It seems to be difficult for those people to understand. I am certainly happy to work with my colleagues in Victoria and the Commonwealth to make sure that the services and the efforts we are applying, which include and should include people saying no to drugs, continue and are effective.

The Hon. ELISABETH KIRKBY: It is a fact that in 1997 New South Wales spent only 25 cents per capita on education directed at the abuse of tobacco, compared with 35 cents per capita in 1995? Will you explain why the funding has declined, particularly when 10 years ago a higher level of funding was associated with declining smoking rates among both adults and children?

Dr REFSHAUGE: It is important to realise that messages in education and preventive programs in regard to drugs do not always work if they are specifically targeted to one drug. I assume you have had experience in raising children. If your child says, "I'm interested in trying heroin", you do not ignore every other aspect of his life. On the other hand, if someone says that he wants to go out and get drunk, you would not talk about issues in regard to smoking or other drugs. The idea that they are so divisible that you can have totally separate programs is something we have learned over time to be not necessarily so. Some programs would and should be targeted to specific drugs, which is quite reasonable and will continue. However, as we learn from what we have been doing and the successes we have had, it is often important to change that mix and put it into more general or more targeted groups, rather than just make the advertisers happy by putting out advertisements.

The Hon. ELISABETH KIRKBY: Is the Minister aware of a report in the Australian New Zealand Journal of Public Health which states that smoking by adolescents demonstrates a growing inequity in expenditure on antismoking activities, compared with the revenue that is gained by government from the illegal supply of cigarettes to
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children? In New South Wales that revenue is estimated at $13 million, of which manufacturers collect $6 million and tobacco retailers collect $5 million. Do you not believe that, as you are getting the revenue, some of that revenue could be spent on smoking education campaigns solely directed at children?

Dr REFSHAUGE: The Federal Government now collects all tobacco revenue. The argument has been used to some degree that funding comes from that source. At the present time, as a result of the High Court challenge on wholesale sales tax, tobacco revenues go to the Federal Government.

The Hon. ELISABETH KIRKBY: That is being refunded to you by the Commonwealth, is it not, despite the High Court ruling?

Dr REFSHAUGE: But it is the Commonwealth Government’s collection.

The Hon. ELISABETH KIRKBY: I see in the budget papers that the funding for the Health Care Complaints Commission has been increased. The explanation is that there will now be patient support officers. Apparently those patient support officers will be at only seven locations. How can those officers, serving at only seven locations, possibly cost $5 million?

Dr REFSHAUGE: They do not. Could you give me the page number?

The Hon. ELISABETH KIRKBY: That is the sum of money that you will find, Minister.

Dr REFSHAUGE: I think other things might have been funded from it. I am happy to take that question on notice.

The Hon. ELISABETH KIRKBY: Budget Paper No. 4 indicates that it will be $5 million, which seems an awful lot.

Dr REFSHAUGE: That is the total cost of the commission; not the patient support officers. The total budget is $5 million. The patient support officers have been partially funded from internal sources this year.

CHAIR: Will you still take that question on notice?

Dr REFSHAUGE: I pointed out that the $5 million is the total cost of the commission; not the patient support officers. The question is not relevant in that sense.

The Hon. ELISABETH KIRKBY: Could you provide the cost of the patient support officers?

Dr REFSHAUGE: I am advised that it is about $270,000.

The Hon. ELISABETH KIRKBY: If they are to serve a useful purpose in a State the size of New South Wales, seven locations seems a very small number. Many people will find it impossible to access them to explain their problems.

Dr REFSHAUGE: At the moment we want to make sure that the way in which they work is effective. The early indication is that it is certainly very effective and so far people have not had difficulty contacting them. We want to make people more aware of their existence and we are looking at ways to ensure that people are so aware. They have been very successful in resolving issues at a local level before they have become major problems.

The Hon. ELISABETH KIRKBY: The capital works program includes a new 15-bed inpatient facility at Wallsend, at a total cost of $4.3 million, of which $1 million will be spent this financial year. I am sure you remember what happened when Wallsend District Hospital was to be closed. Why is it now believed necessary to spend $4.3 million for a 15-bed inpatient facility when only a few years ago the hospital was regarded as expendable?

Dr REFSHAUGE: It was not regarded as expendable by me, that is why I fought for its retention, certainly as a health care facility. The facility will collocate the family care cottage with other services and provide support services for parents in the Hunter. It is not, in that sense, a general hospital with 15 beds. It will focus on the issues and needs of new parents. Inpatient services will be provided for parents in the Hunter and adjoining areas, particularly those who have parenting problems such as feeding difficulties, and infant and toddler behaviour problems; for special groups of families, such as those referred by the Department of Community Services; and for mothers with mental disorders, including moderate to severe nonpsychotic depression. In that sense, it will be a much more specialised facility providing inpatient services for new mothers as well as a family care cottage.

The Hon. ELISABETH KIRKBY: Such a facility, particularly for people with a psychotic illness, is still necessary at Wallsend, even though there is a major mental health hospital in Newcastle - in fact, it is one of the biggest mental health hospitals in the State.

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Dr REFSHAUGE: The facility will be for mothers with babies.

The Hon. ELISABETH KIRKBY: Will mothers go into the hospital with their babies if they are suffering from postnatal depression?

Dr REFSHAUGE: That is certainly an option we will provide. It is not my decision; it is a clinical decision made at the time.

The Hon. ELISABETH KIRKBY: In this year's budget $2.7 million has been allocated for the detoxification centre at Fairfield. Will the Minister tell me how many other detoxification centres there are in New South Wales and where are they situated?

Dr REFSHAUGE: I will take the question on notice and I will provide the honourable member with a full list of those centres.

The Hon. ELISABETH KIRKBY: I am aware of the need in the Fairfield area because of the problems in western Sydney. I have no objection to that amount of money being spent. There are drug problems all over the State - in the far west, in the north and in south. Those areas also need the sort of assistance and the sort of centre available to the people of Fairfield or western Sydney.

CHAIR: Will the Minister take that question on notice?

Dr REFSHAUGE: Yes.

The Hon. ELISABETH KIRKBY: Minister, during another committee hearing it was brought to my attention that there is a practice of moving patients who are occupying long care beds in a dementia unit in a State nursing home to the acute ward of a hospital over weekends because of staffing problems. This is causing great distress to the patients and, I would have thought, great expense to your department. If they are in a nursing home that is funded by the Federal Government and they are moved into acute care beds in your hospital, that funding is transferred back onto you. Can you tell me whether this is happening on a regular basis? If so, have you any method of stopping it?

Dr REFSHAUGE: Firstly, there is obviously a need for somebody in a dementia unit who has an acute episode to be in hospital - that would be a clinical decision. What you are describing excludes that. I am not aware that that is happening. I cannot think of any circumstances where it would be appropriate for it to happen, unless the services close down for some reason or are not available.

The Hon. ELISABETH KIRKBY: Apparently there are problems of staffing and feeding on Saturdays and Sundays.

Dr REFSHAUGE: I am happy to look at any information you have on that, investigate it and get back to you.

The Hon. ELISABETH KIRKBY: I refer the Minister to Budget Paper No. 3, Volume 2, page 480, which refers to specialist Aboriginal health. The recurrent budget for specialist Aboriginal health was underspent by $3.3 million last year, which is 18 per cent of that budget. Why did that happen?

Dr REFSHAUGE: I explained that in response to an earlier question. The Government has a partnership agreement between the Health Department and the Aboriginal Health Resources Co-operative, which is the peak body of the Aboriginal community-controlled health organisations. As part of that agreement, any overview of funding goes through that partnership for agreement before it actually occurs, which sometimes causes a delay. Obviously the Aboriginal Health Resources Co-operative wants to consult its community and to ensure that it is in agreement with the proposal. It can modify it if it wants to. That sometimes leads to the funding that we have available not actually being expended until that process has been gone through. It is not my intention, as you would imagine, to not continue to fund those things. I would not want to undermine in any way the consultative process of the Aboriginal communities for any reason.

[Time expired.]

[Short adjournment]

The Hon. HELEN SHAM-HO: I refer to Budget Paper No. 3, Volume 2, page 480, subprogram 49.1.2, Aboriginal Health Services. In particular, I refer the Minister to Aboriginal health facilities at Boggabilla. Has the $160,000 allocated to Aboriginal health services at Boggabilla been spent as intended? If not, is it still available? Have the funds been maintained for this purpose during the year, or have they been diverted and then paid back? If they have been diverted, to what project were they diverted?

Dr REFSHAUGE: I am advised that there has been no diversion of funding. I do not think the funding has been expended.

The Hon. HELEN SHAM-HO: It has not been spent?

Dr REFSHAUGE: The full amount certainly has not been spent. I am not sure if any of it has been
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spent. It may be that some small amount has been spent, and the intention is that it will be spent. It has not been diverted.

The Hon. Dr B. P. V. PEZZUTTI: I refer to subprogram 49.2.2, Overnight Acute Inpatient Services, on page 486 of Budget Paper No. 3, Volume 2. It shows an increase in budget expenditure of some $150 million compared with last year. If the Minister refers to page 485, he will see that the number of patients treated as inpatients was 723,000 budgeted for and expended last year and the year before, and this year he expects 723,000 to be treated. How does this budget item grow so rapidly in a time of relatively zero inflation and with otherwise stable costing?

Dr REFSHAUGE: There is no stable costing. An increase in wages has to be taken into account, and there is obviously a large number of employees: the average staffing is, I think, 42,000.

The Hon. Dr B. P. V. PEZZUTTI: The staffing has remained relatively stable.

Dr REFSHAUGE: But the award has increased.

The Hon. Dr B. P. V. PEZZUTTI: Does the increase relate only to payments for staff?

Dr REFSHAUGE: No, not only that. It would also include the increased cost of technology. As you are aware, there has been an increase in the use of stents for coronary artery surgery - the cost of which is between $2,000 and $3,000 - so new technology would increase the cost of operations. In addition, the specialised drugs used in conjunction with the stent cost approximately $1,600. Therefore, the way in which medical technology and medical practice is going will lead to significant increases in the cost of the otherwise equivalent operation. A number of factors would be involved, of which wage increases would be a major part.

The Hon. Dr B. P. V. PEZZUTTI: That is about half the health budget. I note that this year, despite the huge increase in expenditure and the fact that no additional patients have been treated and no additional staff employed - in fact, there have been some variations in the retained revenue section, just to help you out a bit - you expect a big increase in retained revenue while the cost of services continues to rise dramatically.

Dr REFSHAUGE: The intensity of care and the complexity of the case mix of the patients have increased, and will continue to increase. The example I gave in relation to coronary artery surgery and the use of stents - I think it is called Reopro, which is used in conjunction with them - can add $5,000 to the cost of the service, and that is merely one item.

The Hon. Dr B. P. V. PEZZUTTI: That has to be compared with the cost of admitting a patient for open cardiac surgery, which is vastly more expensive. This procedure would involve a reduction in cost for that particular item of service.

Dr REFSHAUGE: It could be if we were to reduce the number of patients being admitted, but we are not; we are providing more costly service on medical advice. The Leader of the Opposition has highlighted the issue of the wages paid to New South Wales nurses, doctors and teachers. We stand proud: we are prepared to pay our staff. All public sector employees should know that the coalition's policy is to reduce their wages.

The Hon. Dr B. P. V. PEZZUTTI: I refer to Budget Paper No. 4 and the State asset acquisition program. I was interested in the question from the Hon. Elisabeth Kirkby and the Minister's answer to it. Would the Minister explain why 10 multipurpose services currently under construction in rural New South Wales had their capital works allocation underspent and their estimated completion dates pushed back by up to two years? Will the Minister guarantee that health services have been and will be maintained at each of the 10 centres until construction delayed by him is finalised? How many rural communities have expressed an interest in having a multipurpose centre established in their town, apart from the ones already announced?

Dr REFSHAUGE: First, the Commonwealth Government has cut back its contribution to multipurpose services - a decision I am hoping it will change.

The Hon. Dr B. P. V. PEZZUTTI: The Federal Minister announced an increase in that expenditure in the last budget, as the Minister is well aware. I have a press release upstairs.

Dr REFSHAUGE: The cutback on the present program is unfortunate; it certainly has not been welcomed by country New South Wales.

The Hon. Dr B. P. V. PEZZUTTI: An amount of $34 million, Minister.

Dr REFSHAUGE: And the cutback has not been welcomed by those of us who have been trying to get these multipurpose centres going. Of course, as the honourable member is aware, the community consultation process is an important part of making sure that the communities are aware of, and are supportive of, multipurpose centres.

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The Hon. Dr B. P. V. PEZZUTTI: These are projects you have announced. Therefore, I presume that you undertook consultation beforehand?

Dr REFSHAUGE: The 11 sites that I described earlier certainly are at different stages of development. We expect them to be commissioned on time - all of them within two years, and some of them earlier than that. The contribution of the New South Wales Government will be in excess of $26 million for capital. The Commonwealth Government has contributed only $3.2 million per eight MPS sites in phase one. In 1997-98 the Commonwealth Government announced that it would not contribute to the further capital costs of the remaining sites in phase one or any future MPS sites.

The Hon. Dr B. P. V. PEZZUTTI: I have a press release from Mr Warwick Smith, to whom I spoke only two weeks ago.

Dr REFSHAUGE: Consistent with the New South Wales Government's intention to raise the priority of rural health, we have, in conjunction with the Commonwealth Government, commenced planning for phase two of the MPS program. Approximately 11 sites could be progressed in 1998-99. The establishment of these sites is contingent on the availability of aged care licences from the Commonwealth. A number of communities have been seeking aged care licences from the Commonwealth. Not all of them have been agreed to by the Commonwealth. So far of the order of 50 communities have been interested in MPSs - the number sometimes changes because communities change their minds. The Culcairn MPS is to have about 27 beds: five acute, 12 hostel and 10 nursing home beds. That hospital has already undergone refurbishment.

At Delegate the total cost is about $1.7 million. The local community contributed about $100,000 and the Commonwealth Government contributed only $200,000, out of a total of $1.7 million. It will have about 12 beds in total - four acute and 12 nursing home beds. In addition, the Delegate MPS will operate two community aged care packages. The Delegate MPS is a totally new purpose-built facility. Previously there was no appropriate residential aged care services in Delegate. At Dorrigo, which has a more expensive and a bigger service, the total cost is about $2.4 million. There are about 27 beds there.

The Hon. Dr B. P. V. PEZZUTTI: The subject of my next question was raised by the Hon. Elisabeth Kirkby and it relates to Budget Paper No. 3, Volume 2, page 493. What were the New South Wales allocations to the mammography and cervical cancer screening programs for each financial year following the transfer of these programs from the Cancer Council in 1996? What is the projected allocation for each of these programs in 1998-99?

Dr REFSHAUGE: I do not have the details of that. I will take the question on notice.

The Hon. Dr B. P. V. PEZZUTTI: I refer again to Budget Paper No. 3, Volume 2, page 473. How many voluntary redundancy packages were offered in 1997-98? How many were paid out in 1997-98? At what cost? How many redundancy packages are anticipated this year?

Dr REFSHAUGE: Again, I do not have the specific details of those packages, but I will provide the information to the honourable member on notice.

The Hon. Dr B. P. V. PEZZUTTI: I refer to Budget Paper No. 3, Volume 2, page 491, subprogram 49.4.1, Rehabilitation and Extended Care Services. Last year's estimates claimed that the rehabilitation and extended care service staffing numbers would be increased overall by 1,091 equivalent full time in 1997-98. Will the Minister explain why the number of staff decreased from 7,684 in 1996-97 to 7,431 in 1997-98? Why is that number to remain static in 1998-99?

Dr REFSHAUGE: I will come back to that question and provide more details, but certainly there has been some refining.

[Short adjournment]

CHAIR: Minister, do you remember the question you were answering?

Dr REFSHAUGE: It concerned rehabilitation. I am not convinced that the issue in regard to clearly defining each policy area which would lead to changes of the dollar value to the program and to the staffing numbers fully explains that. I think it may, but I will seek further advice to make sure that there is no other explanation.

The Hon. Dr B. P. V. PEZZUTTI: I refer again to the multipurpose centres. I quote from a press release, dated 12 May 1998, from Minister Warwick Smith:

As part of the 1998-1999 budget a $24.3 million package over four years will include the delivery of health and family services to rural and remote families by establishing a rural multi-purpose and family service network.

Under this new package 30 new multipurpose services will be established in rural and remote areas. I wonder, Minister, if you have caught up with your reading lately?

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Dr REFSHAUGE: No. There is no doubt that the Commonwealth has recognised the error of its ways, but there is no guarantee that any of that money will come to New South Wales. I certainly hope that you will enlist your party's support for a fair share of that coming to New South Wales.

The Hon. Dr B. P. V. PEZZUTTI: I have already done that.

Dr REFSHAUGE: The Federal Minister has been less than forthcoming in guaranteeing that New South Wales will get its fair share.

The Hon. Dr B. P. V. PEZZUTTI: A most approachable Minister he is, too. I refer to Budget Paper No. 3, Volume 2, page 489. Mental health service staffing numbers were budgeted to rise by 260 in 1997-1998 to 5,860 EFT. Will the Minister explain why the number of staff increased by only 150 in 1997-1998? What mental health services missed out because 110 additional staff did not materialise?

Dr REFSHAUGE: Not all of the staff would necessarily be factored in under subprogram 49.3.1. The number of recipients of mental health services has increased in the community health and acute overnight areas, I do not believe the figures you have cited reflect the totality of things.

The Hon. Dr B. P. V. PEZZUTTI: My figures came out of last year's budget papers, Minister.

Dr REFSHAUGE: Yes.

The Hon. Dr B. P. V. PEZZUTTI: So last year's budget papers were wrong?

Dr REFSHAUGE: No, I am saying that each year we make sure that the programs are as active as possible, that there are changes between the programs. It is probably one of the most comprehensive budget papers that you have ever seen. Part of the change has been to create greater clarity about where particular programs or expenditure in those programs should be sited.

The Hon. Dr B. P. V. PEZZUTTI: I refer to Budget Paper No. 3, Volume 2, page 474. Given that the Department of Health RDF formula indicates that the Northern Rivers Area Health Service is underfunded by between $15 million and $20 million annually, will the Minister implement the RDF fully in 1998-1999 as promised? If not, when is it expected to be fully implemented?

Dr REFSHAUGE: Is there not a conflict of interest that you would like to raise about that? Did you actually receive any money as a result of this?

The Hon. Dr B. P. V. PEZZUTTI: No.

Dr REFSHAUGE: Do you want to declare a potential conflict of interest?

The Hon. Dr B. P. V. PEZZUTTI: No.

Dr REFSHAUGE: There is no doubt that under the former Government there were massive disparities in funding for different area health services, and one of those areas was, of course, what is now known as the Northern Rivers Area Health Service. Despite a large criteria, there was significant underfunding by the coalition Government. In fact, in 1994-95 the area health services received only $143,308,000 from the coalition Government’s budget. Each year the Carr Labor Government has increased that funding. There was an increase in 1995-1996 up to $141,611,000; in 1996-1997 up to $151,081,000; and in 1997-1998 $162,699,000.

As I said, the budgets have not been finalised for the area health services this year. However, as you can see our significant increases each year - almost $30 million more for the Northern Rivers area - were not always achieved easily. We have worked hard to do that. I am proud that we have been able to achieve such a significant increase in funding - a 25 per cent increase in funding. It would be difficult to find an area that had a 25 per cent increase in funding in any of the seven quiet years of the coalition Government.

The Hon. Dr B. P. V. PEZZUTTI: If that is the case, why have the waiting times increased and the level of debt increased from almost zero to $12 million over the same period?

Dr REFSHAUGE: Before I answer that question, I point out that there has been significant capital expenditure in the Northern Rivers Area Health Service.

The Hon. Dr B. P. V. PEZZUTTI: I will come to that, Minister.

Dr REFSHAUGE: The $1.5 million budget allocation this year is for stage three of the Tweed development, the Ballina redevelopment, the Grafton Hospital redevelopment, the family health post at Wolli development and the Murwillumbah co-location. So there has been significant effort by this Government to an area that was neglected by the former Government, and we are certainly making major progress.

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CHAIR: I ask the Hon. Dr B. P. V. Pezzutti whether he wants his question on waiting time answered?

The Hon. Dr B. P. V. PEZZUTTI: I asked why waiting times had increased and why the level of indebtedness for that area increased by $12 million over the last three years when it was relatively debt-free before that?

Dr REFSHAUGE: One of our biggest problems is that the Federal Government is unable to find a policy that works in relation to private health insurance - each year it tries things that fail, and every hospital, including those in the Northern Rivers Area Health Service, is feeling the dramatic effects of the fallout of private health insurance. There has been an almost 11 per cent fall in private health insurance levels in the time of this Medicare agreement: from 42.3 per cent of the New South Wales population down to 31.4 per cent - almost 700,000 fewer people in New South Wales pay private health insurance. Every 1 per cent drop, without compensation from the Federal Government, adds 3,000 people to public hospital waiting lists. Therefore, a drop of 11 per cent in the life of the Medicare agreement has put 33,000 people onto our hospital waiting list, and there has been no compensation from the Federal Government.

These figures have been confirmed by other States. Not only New South Wales is saying this; every State in Australia is saying it. If we had the funding review that was agreed to - that every State Minister is saying Michael Wooldridge has not delivered on - we would have significant funding increases to our public hospitals to cope with, in New South Wales the 3,000 extra people wanting to get into our public hospitals as a direct result of John Howard's failed policies on private insurance. We do not get that increased funding and, as a result, our waiting list increases by 3,000 for every 1 per cent drop. The cumulative effect would make it significantly higher than that.

The Commonwealth Government has been tardy in funding health care. As a result, New South Wales faces the net cost burden of an extra $450 million annually. In addition, the Commonwealth Government has used public money to try to prop up private health insurance. It has committed $1.8 billion of the first $600 million that was provided for private health insurance. The Industry Commission said that less than half of that made any difference, but not 1¢ of that treated a patient. Therefore, $600 million of taxpayers' money was sent out of Canberra's coffers for health and did not treat a patient. If that money had gone to public hospitals around Australia we could have treated a significantly increased number of patients, and the decreased level of private insurance would have been compensated for, as it should have been, by the Federal Government.

I have just received a media release from the South Australian Minister for Human Services, the Hon. Dean Brown, who absolutely and totally supports my assessment that the Commonwealth Government has not been providing adequate funding. He says very clearly that since the Medicare agreement of 1984 there has been a swapping over of responsibility for funding our public hospitals. He says that in 1984 the State governments contributed 45.3 per cent to public hospital expenditure and the Commonwealth contributed no more than 4.7 per cent.

The Hon. Dr B. P. V. PEZZUTTI: I refer to Budget Paper No. 2, page 4-11. The Minister told last year's estimates committee hearings that the sale and lease back of Department of Health motor cars would be "cost neutral". Will the Minister explain the Treasurer's claim that the "other factors contributing to the real growth in expenses include . . . motor vehicle lease costs following the sale of the Department of Health's motor vehicle fleet in 1998-1999"? What additional expenses will the lease of cars incur during 1998-1999?

[Time expired.]

Dr REFSHAUGE: I suggest that the honourable member direct his question to the Treasurer.

The Hon. ELISABETH KIRKBY: I refer the Minister to Budget Paper No. 4, page 61. There seems to be a disparity between the money that has been given to the New South Wales Medical Board and the money that has been given to the Department of Aboriginal Affairs. There is a program for replacement of plant and equipment for the Medical Board for $290,000, but a program for the acquisition of minor plant and equipment for the Department of Aboriginal Affairs for only $40,000. Will the Minister explain the disparity, as the Medical Board is surely funded from the registration fees of all the doctors in this State?

Dr REFSHAUGE: I am advised that the Medical Board is totally self-funded, so how it spends the doctors' money it collects is up to it.

The Hon. ELISABETH KIRKBY: But it still applies in your -

Dr REFSHAUGE: I have to report on it.

The Hon. ELISABETH KIRKBY: I see, but they have paid it.


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Dr REFSHAUGE: Yes.

The Hon. ELISABETH KIRKBY: Will the Minister explain the priority mental health programs referred to in Budget Paper No. 2?

Dr REFSHAUGE: I would prefer the honourable member to ask me that question later in the year because a number of details are still being worked out. A number of issues are of importance to us in relation to mental health, including child and adolescent health, suicide prevention, and the geographic underserving, or less serving, in rural New South Wales, south west of Sydney, the Illawarra, the Hunter and the central coast. Individual projects have not been finalised to a stage where I can list them, but in the broad they are the sorts of areas that we have particularly been focusing on, areas that I think have not had the focus that they should have had in the past. I am keen to progress those areas, which are of significant importance.

The Hon. ELISABETH KIRKBY: Budget Paper No. 4, page 59, refers to the relocation of the Prince of Wales HIV-AIDS unit, which will cost approximately $3.5 million. Will the Minister explain where that unit will be relocated to, and why such a large sum of money is being spent on its relocation?

Dr REFSHAUGE: It will move from Prince Henry Hospital to Prince of Wales Hospital. Acute care services are being consolidated on the Prince of Wales Hospital site, and construction of a new level, level 4, is taking place on the existing Dickinson building at Prince of Wales Hospital. That unit will provide 28 infectious disease beds, with associated allied health and administrative support services. It will transfer the HIV-AIDS inpatient services from Prince Henry Hospital to Prince of Wales Hospital. We expect it to be completed later this year, and it has the support of the Aids Council of New South Wales, ACON, and People Living With Aids, PLWA.

The Hon. ELISABETH KIRKBY: What will happen to the HIV-AIDS unit at Prince Henry Hospital as it currently exists? Will Prince Henry Hospital be downgraded in the future?

Dr REFSHAUGE: In conjunction with the groups that represent those at risk, there has been a commitment to move the HIV-AIDS unit to Prince of Wales Hospital from Prince Henry Hospital. The former coalition Government started the significant move of acute services from Prince Henry Hospital to Prince of Wales Hospital and started the plan for the rebuilding of Prince of Wales Hospital - however, the coalition planned to have it privatised; to have public sector ownership. Those moves are continuing and, as part of that, the HIV-AIDS unit, as I say, with the concurrent support of ACON -

The Hon. Dr B. P. V. PEZZUTTI: You broke a promise, did you not?

The Hon. ELISABETH KIRKBY: I refer to Budget Paper No. 4, page 58, line item "State Government nursing home strategy stage 1" for which $11.5 million has been allocated. Will the Minister explain how that $11.5 million will be spent? Will there be matching funding from the Commonwealth Government, because it relates to nursing homes?

Dr REFSHAUGE: There will be no matching funding on the capital. However, we would obviously want to continue with the CAMSAM from the Commonwealth for the recurrent costs. In 1991 all of the Australian health Ministers agreed that the responsibility for funding of nursing home accommodation should move to the Commonwealth Government, and changes in the funding of the State government nursing homes was considered to free the State's funds for expanded community-based aged care services. All of the State government nursing home approvals were transferred to Commonwealth CAMSAM funding in December 1995 and the State Government nursing homes will now be assessed against the Commonwealth outcomes standards, which will contribute to the provision of high-quality care for the aged.

However, many of the old State government nursing homes do not meet contemporary standards. Therefore, we are looking at substantially upgrading the capital stock to fit in with the quite reasonable Commonwealth standards. The Government considers the nursing homes of priority and most in need to be Allendale Nursing Home, Garrawarra Centre for Aged Care, Red Cross at Wentworth Falls, Governor Phillip, Mount St Joseph at Young, St Joseph's at Sandgate, and Macquarie Care Centre. Some of the work has already been commenced.

The Hon. ELISABETH KIRKBY: Will it be possible for the Government to provide further State government nursing homes under this strategy, or will it be tied by the number of licences the Commonwealth Government is willing to provide for nursing homes?

Dr REFSHAUGE: The Government is restricted by the number of licences.

The Hon. ELISABETH KIRKBY: Is there any possibility of persuading the Commonwealth Government to expand the number?

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Dr REFSHAUGE: I would have hoped that there would be, considering the ageing of the population. However, for many years a number of my colleagues have been trying to get the Commonwealth Government to change its mind, and they have been unsuccessful thus far. The Commonwealth Government has to review its aged care policies. The early changes caused major concern in the nursing home industry and among older people. I do not believe that the Commonwealth Government got it right. Certainly some changes are difficult, but it is important for the Commonwealth Government to make a concerted effort to look at not only the short-term interests but also the long-term interests of New South Wales, of Australia, so that we can get a more comprehensive commitment from it. The New South Wales Government is happy to work with the Commonwealth Government to help it get there.

The Hon. ELISABETH KIRKBY: I refer to the northern Sydney strategy, which is on page 156 of Budget Paper No. 4. The strategy provides for the upgrading of the emergency department intensive care units and operating theatres at Royal North Shore Hospital and the Ryde community health centre. However, no money is available for any further upgrading of Hornsby Hospital. As Hornsby Hospital is so close to the freeway and is possibly the first hospital that could be accessed if there was a very serious accident on the freeway, and is serving an increasing area of population, will the Minister explain why no money is to be spent at the hospital?

Dr REFSHAUGE: To some extent, I need to rely on the expertise and advice that I receive from the local level. The hospitals that are being funded are seen to be higher priorities and, as I have said to many people and as I am sure my colleagues around the country have said to many people, if the Commonwealth provided more money we would be able to do more. However, it cannot be suggested that we are not looking at areas that have not received capital funding this year, to ensure that people do not miss out. The Carr Labor Government’s capital budget in four years is $1.8 billion, compared with the last four years of the former coalition Government when its capital budget was a little over $1.3 billion. That is a significant amount of funding, which has not been easy to achieve, particularly in the context of Federal cuts.

The Hon. ELISABETH KIRKBY: As I have gone through the budget papers I have found it difficult to work out exactly how much money is to be spent on corrections health. The health budget allocates funds for the refurbishment of the prison hospital at Long Bay Gaol. However, the budget for the Minister for Corrective Services indicates that there will be a drug and alcohol therapeutic unit and acute crisis management unit. Are those one and the same thing? Will the Minister tell me where the funding for corrections health as an entity comes from? Does it come from your budget or from the budget of your Cabinet colleague the Minister for Corrective Services?

Dr REFSHAUGE: The two capital items are separate items. The vast majority of the corrections health budget comes from health. Correctional services run a health program that they fund. Sometimes we transfer funding from health to correctional services for some specific items. Basically, the corrections health budget is effectively out of health, but there will be some minor items -

The Hon. ELISABETH KIRKBY: Information from various reports that have been brought down by the Department of Corrective Services and by the Department of Juvenile Justice suggests that a large number of inmates are drug and alcohol dependent when they are admitted to a corrective centre. Is the only therapeutic unit and the only acute crisis management unit to be at Long Bay Gaol, or will they also be at Grafton, Maitland and other gaols in the State?

Dr REFSHAUGE: Each of the gaols will have its own health service. Some services are highly specialised and are more likely to be in one gaol rather than replicated, and little used, throughout the system. My understanding is that inmates are transferred from one site to another site if they require the specialised services that would be available in another site. If they require inpatient hospital care there may be time to transfer them to an appropriate secure place in a hospital.

The Hon. ELISABETH KIRKBY: If they are admitted with an addiction, would they be put on some type of program to assist them to overcome that addiction before they were moved to the normal area of the gaol to serve their sentence, or does the situation still pertain where they have to try to cope with their addiction without any specialised medical or psychological help?

Dr REFSHAUGE: That would be a clinical decision for the medical practitioners involved in each individual case. Some will be transferred to an appropriate site if they have a major problem, but not all would require that.

The Hon. ELISABETH KIRKBY: I am aware that the Government has established a linear accelerator in Penrith - in spite of the fact that there are other linear accelerators in the greater Sydney area,
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particularly one as close as Westmead - and another unit is to be established at the new Liverpool Hospital. Will the Minister tell me why the money being spent on further units in the Sydney metropolitan area or greater Sydney area has not been diversified? Why has a unit not been established in southern New South Wales, central New South Wales or northern New South Wales so that patients from those areas do not have to come to Sydney and, in many cases, spend six weeks having daily treatment for their cancer? People find coming to Sydney expensive and extremely traumatic if they cannot bring a family member with them.

Dr REFSHAUGE: Your question raises some important issues. In general, we are following expert advice on where we should be siting linear accelerators and how many we should have. In general, that is what the former coalition Government also did. The latest report was formulated under the former Government, so we are not in any significant disagreement there. In that sense I think it is legitimate to have a linear accelerator for Liverpool and one for Nepean. The siting of linear accelerators outside major metropolitan areas is an issue that has concerned me. It has been suggested that a number of country sites could possibly have sufficient work to justify the establishment of such units. One of the difficulties is that this is a joint Commonwealth-State responsibility, and we need to ensure that the guidelines that have been established are able to be met.

Recently I wrote to the Federal Minister for Health to try to get through an impasse, not of his making, about siting linear accelerators or radiotherapy units in rural areas. One of the problems is that people say they should have two units on any one site because one could go down. However, the best estimate is that none of the centres would have the volume or workload to support two units. I have suggested to him that perhaps two single sites in country New South Wales could effectively be a de facto unit with two sites, but it might be in two different towns. He certainly has shown some positivity towards this, but it is difficult to reach agreement. In this regard I have received support from the coalition members who represent those electorates.

I have taken the view that, despite the fact that the assessment figures may not totally add up, we need to look at the social issues in the community: the significant distances people have to travel and the options people might lose if we cannot progress this issue. I take on board your concern, as it is much the same as mine. I do not want to undermine what we are doing in Liverpool or Nepean, but I want to add to that and try to work with the Commonwealth Government to get there. I have had some discussions with my Victorian colleague about this issue. We are trying to find a better way to service country Australia.

The Hon. ELISABETH KIRKBY: It is a fact that if patients from the north of New South Wales decided to go to Brisbane for treatment instead of to Sydney, or if patients from the south of New South Wales decided to go to Melbourne, that would distort the health budgets of both the Queensland and Victorian governments because the costs would be transferred with them?

Dr REFSHAUGE: We pay for them if they travel.

The Hon. ELISABETH KIRKBY: Even if they travel interstate to get their treatment? I thought it was the other way around. I thought you then charged the State in which they receive the treatment.

Dr REFSHAUGE: No, for all inpatient services we pay or receive payment for patients treated in a different State. The State of residence pays for the treatment in the State where the treatment is provided.

The Hon. ELISABETH KIRKBY: A few moments ago we spoke about the money available for mental health services. It is stated on page 155 that mental health services are to be available 24 hours a day, seven days a week. Are you aware that in some country towns mental health and youth suicide counsellors have to be shared among rural communities? Those services are certainly not available 24 hours a day, seven days a week.

Dr REFSHAUGE: Yes, I am aware of that. As much as possible we want to ensure that we provide individual specialist services, so long as the service workload is reasonable. As the honourable member knows from her work and travel in rural New South Wales, often people have to be multiskilled because of the range of services that people expect with few staff available. The Government is targeting areas of need, including rural New South Wales. Those are some of the issues we are looking at.

The Hon. ELISABETH KIRKBY: I note that money is to be made available for magnetic resonance imaging through the Commonwealth grants. Where will that facility be established? At present there are few government facilities at which a person can have MRI, and it is an expensive procedure if one goes to a private clinic. In addition, it is not claimable even if one has private health insurance.

Dr REFSHAUGE: The Federal Government has made some changes in its recent budget. It will
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effectively stop funding public sector MRIs and it will put funding into providing a rebate for private sector MRIs. That will affect our recurrent costs, because the cost of public patients having MRIs at the moment is being funded by the Commonwealth, and the Commonwealth is going to withdraw that funding. Other States are also concerned about that. This again is classic cost shifting of the Federal Government to the States. We have having discussions, which have so far borne no fruit, to get the Commonwealth Government to realise this is not fair or appropriate.

The specific item to which the honourable member referred is at North Shore Hospital, where a joint research and commercialisation of MRI technologies has been set up with significant public sector funding and some Federal and State funding. From memory, some of the State funding comes from health and some comes from state development. The Government sees this not as a treatment service - although it may provide treatment or a diagnostic service - but more as developing the commercialisation and research into what MRIs may be able to do. General Electric has provided a significant amount of funding, which the Government announced some time ago. The research unit has been officially opened and the person who heads the unit has impressive credentials. It is expected that MRI may be able to dramatically improve diagnostic effectiveness.

The Hon. ELISABETH KIRKBY: And, therefore, in the long run save money?

Dr REFSHAUGE: And to have it done in Australia is, I think, a significant advance. In the future we may become world leaders in a number of aspects of MRI technology, but this is basically a research institute with mostly private sector investment but with joint Commonwealth and State contributions.

The Hon. ELISABETH KIRKBY: I have been made aware that the use of cooked chilled food is, in many cases, particularly unsuitable for elderly patients or patients with dementia. Has your department done a cost-benefit analysis of the closing down of hospital kitchens and the use of cooked chilled food? I understand that, in many cases, the provision of suitable food for older patients has meant that the hospital or nursing home has had to go back to preparing its own food. The sort of food that might be suitable for a reasonably able-bodied sick young person is not the sort of food that is valuable for an older person who may be in a very frail state.

Dr REFSHAUGE: The move towards cooked chilled food started some time ago. A number of assessments on a financial basis have shown that in many cases it could be financially beneficial and the savings could be put into patient care. Some units have decided that they would prefer to go back to preparing their own food, but they have been few in number compared with the number moving towards cooked chilled food. Nutritionists are keen to ensure that the nutritional value of the food provided in hospitals is adequate.

[Time expired.]

CHAIR: This is the last time the Hon. Elisabeth Kirkby will serve on an estimates committee, as she is soon to retire from Parliament. It has been a privilege to serve with her.

Dr REFSHAUGE: I endorse that.

The Hon. HELEN SHAM-HO: I noted your detailed answer in response to a question from the Hon. A.B. Kelly, but I would like you to answer my questions specifically. Budget Paper No. 2, page 4-153, refers to the Aboriginal communities development program. I note what you have already said about that. Apparently the program is to be funded to the amount of $10.75 million next year and $200 million over seven years, an approximate average of $28.6 million per year. Will the Minister tell the Committee where this money is coming from? Is it part of the half a billion dollars held by the New South Wales Aboriginal Land Council? Would you save some of this taxpayer expenditure and still achieve the much-needed outcome for Aboriginal people by seeking assistance from the defence forces and or private industry to develop facilities? Have you approached the Federal Government to seek defence forces assistance?

Dr REFSHAUGE: The honourable member has asked a lot of questions, which I may forget as I go along. Could she ask them one at a time?

The Hon. HELEN SHAM-HO: Where is the money for the Aboriginal communities development program coming from?

Dr REFSHAUGE: It is coming straight from Treasury; it is new money.

The Hon. HELEN SHAM-HO: Is it in any way part of the half billion dollars held by the New South Wales Aboriginal Land Council?

Dr REFSHAUGE: No, although we are happy for the council to add to it if it thinks it would have an interest in the tripartite infrastructure program.

The Hon. HELEN SHAM-HO: Would you save some of this taxpayer's expenditure and still achieve
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the much-needed outcome by seeking assistance from the defence forces or private industry to develop facilities?

Dr REFSHAUGE: Defence force were sent into the Northern Territory at the suggestion of someone who spoke to either the Prime Minister or Senator John Herron on a talk-back radio show. The Northern Territory health Minister has said that it did not work very well; that they were not wanted. They targeted areas that were not priorities, and he has told me that he does not want them back again. It has led to a little bit of hesitancy about charging in with the army. On the other hand, if a community, through this program, is keen to obtain support from a government agency, including the defence forces, it is at liberty to seek that assistance. During the break the Hon. B. P. V. Pezzutti and I discussed this aspect. In some instances a good relationship between the health services and the army health services is an option, but experience to date has not encouraged us to move in that direction.

The Hon. HELEN SHAM-HO: I refer to Budget Paper No. 2, page 4-152. I note that $530 million has been provided to the New South Wales Aboriginal Land Council, which is 415 years of land tax contributions to the fund. What measures will the Minister implement to ensure accountability for this substantial funding? What is it going to be used for?

Dr REFSHAUGE: As I have explained, the principal is to be kept and not used. Any interest from that principal can be used for whatever purpose the land councils determine, which is part of the legislation that was enacted, I think, in 1983. I cannot remember the exact date but an edition of the Business Review Weekly highlighted the fact that there had been a variable success rate with managed funds. The one that stood out as being extremely successful was the Aboriginal Land Council's managed fund, which seemed to do better than the vast majority of private sector managed funds. The Auditor-General audits the council's report, and the last audit was unqualified. Those are the sorts of checks that are in place.

The Hon. HELEN SHAM-HO: Payment to the Department of Aboriginal Affairs is estimated to decrease by 44.7 per cent in 1998-99, relating to stopping the payment to the New South Wales Aboriginal Land Council and the Aboriginal Land Rights Act 1983. Will the Minister explain why there will be a reduction of approximately $23 million in expenses for the department, at the same time as the payment to the New South Wales Aboriginal Land Council will cease? What will the Government do with the savings?

Dr REFSHAUGE: The legislation determines that that is when the funding ceases. An Act of this Parliament determined that is what should happen. We are not breaking the law, we are doing what Parliament said should happen.

The Hon. HELEN SHAM-HO: That is not the question. The question is: why will there be a reduction of $23 million in expenses?

Dr REFSHAUGE: The reduction is because the land council legislation reduces the contribution from land tax to the land council and, therefore, the expenditure reduces by the same amount.

The Hon. HELEN SHAM-HO: So there is a saving?

Dr REFSHAUGE: It is the same money; it is not a saving. Parliament determined that funding should continue until that time, and Parliament determined when it should stop.

The Hon. HELEN SHAM-HO: I refer to Budget Paper No. 3, Volume 2, page 480, subprogram 49.1.2, Aboriginal Health Services. How much funding is targeted to Aboriginal mental health service in urban and rural areas?

Dr REFSHAUGE: That would be very hard to calculate. Many projects cover a multiplicity of issues, such as the family health strategy. Many projects cover mental health but also deal with a large number of health and associated issues. I do not think it would be productive to disaggregate that and say, "This is spent on mental health and this is not spent on mental health." The family health strategy is a $3.1 million project. However, it is not the extent of mental health services, nor is every cent of it spent on mental health. The strategy covers many other issues.

The Hon. HELEN SHAM-HO: Is there a distinction between urban and rural areas? Is there a separate allocation for urban and rural areas?

Dr REFSHAUGE: Once the budgets reach the areas as determined they would give a clear indication of what is in that program item. Some statewide services cover both urban and rural areas. You will get an indication of that from the area health services budgets. Of course, we have a partnership with the Aboriginal Health Resources Co-operative, which is involved in determining funding priorities and strategies.

The Hon. HELEN SHAM-HO: Does that apply to Aboriginal women's health?

Dr REFSHAUGE: Yes.

The Hon. HELEN SHAM-HO: The same principle?

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Dr REFSHAUGE: Yes.

The Hon. HELEN SHAM-HO: Does the same principle apply to the training of Aboriginal health workers?

Dr REFSHAUGE: If you look at Aboriginal health workers in the broad sense, there are a number of training initiatives, some of which are in association with the department but not necessarily initiated by the department, like the -

The Hon. Dr B. P. V. PEZZUTTI: How would he know? He would not have a clue.

Dr REFSHAUGE: I am trying to think. There are a number of training initiatives. Obviously the Aboriginal medical services train some health workers. The Australian Health Care Service has a training program for health service executives. It is a professional organisation, and it has determined that a full year input of trainees should be Aboriginal people only. It has, in fact, set up for training. A lot of the support for that would obviously come through the Health Department. There are a number of factors in that. I refer to the pilot projects in the Aboriginal environmental health infrastructure program at Dareton. I was pleased to see that a number of apprenticeships, while not specifically for Aboriginal health workers, have health aspects to them. The accelerated apprenticeships were strongly supported by the Federal Government and, to give her due credit, even the former Minister, Amanda Vanstone, was supportive of initiating apprenticeships. The public health trainees are also a significant -

[Time expired.]

The Hon. HELEN SHAM-HO: I refer to Budget Paper No. 2, page 4-158. How much funding, in percentage and dollar terms, is directed to the long-term unemployed Aborigines in urban and rural areas?

Dr REFSHAUGE: Unemployment is a significant factor in Aboriginal health status - unemployment leads to worsening health - and much of the work we do is directed to that. If you are talking about the health budget -

The Hon. HELEN SHAM-HO: I am talking about unemployment now.

Dr REFSHAUGE: As the Minister for Health I do not have a specific responsibility. However, as an employer I am keen to ensure that we have a role in employing Aboriginal people, where appropriate, and assisting them to be employed in the health system, where appropriate. I think that is an important social responsibility of any large organisation. The Aboriginal affairs portfolio is a coordinating portfolio rather than an expenditure program, except with this new community development program. In that sense, it is outside our portfolio-specific ability.

The Hon. HELEN SHAM-HO: Are you co-ordinating any programs that would help the Aboriginal unemployment problem?

Dr REFSHAUGE: We have targets for employment in the Department of Health, but our job, our core responsibility, is providing health services. We are not a job-creation department. We hope to create some jobs on the way through, and we are looking at appropriate options for that. However, it is not for me to, effectively, shift money from providing cardiac surgery to employing Aboriginal people doing craft work. That is not in the charter.

The Hon. HELEN SHAM-HO: You have a separate portfolio of Aboriginal affairs.

Dr REFSHAUGE: Aboriginal affairs and health are not aligned portfolios.

The Hon. Dr B. P. V. PEZZUTTI: I was recently involved in a Standing Committee on State Development inquiry and report into fishing rights. The report recommended that the Government look at some form of community fishing right and community access for fishing licences. Have you seen the report? If you have seen the report, did you have any input into the reply that the Minister for Fisheries gave to the Parliament in regard to that recommendation?

Dr REFSHAUGE: That is a question for the Minister for Fisheries.

The Hon. Dr B. P. V. PEZZUTTI: You are not interested at all in Aboriginal people's fishing rights. Page 4-158, of Budget Paper No. 2 states:

The Department will receive additional funding of $0.3 million starting in 1998-99 for the Office of the Registrar of the New South Wales Land Rights Act. Four additional staff will be employed to co-ordinate and manage the Aboriginal Land Claims process and the Aboriginal Ownership Register.

Do you anticipate that there will be an increase in the number of land claims? If so, why? What is your view of this increase?

Dr REFSHAUGE: As a result of the change of government, the processing of land claims has been quicker. During the last year of the former coalition Government there was almost a go-slow on the processing of land claims. The registrar of Aboriginal land rights was created under the Land Rights Act
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and, to date, its primary role has been to assist Aboriginal land councils by writing advice aimed at monitoring and improving their efficiency, effectiveness and accountability, which includes the application model rules as provided by the Act. The Aboriginal Ownership Act increased the registrar's role to include specific duties regarding Aboriginal people in New South Wales who have a cultural association with land.

In addition to land council activities, the registrar now plays a key role in the handing back of a number of national parks to Aboriginal people. In that respect the registrar must maintain a register of traditional Aboriginal owners. The registrar's responsibility, as far as possible, is to enter the name of every Aboriginal person in New South Wales who has a cultural association with land. The intention is to ensure that appropriate negotiation with traditional Aboriginal owners takes place, which will lead to a board of management to manage those parks.

The Hon. Dr B. P. V. PEZZUTTI: Will there be increased numbers of land claims to justify the employment of these four people?

Dr REFSHAUGE: The registrar does not assist local people to develop their land claims. There is a significant increase in the staff requirement because of the Aboriginal ownership of national parks legislation and the potential for native title issues. The return of those parks has taken quite some time - in fact, I think it was initiated by Tim Moore when he was the coalition Minister for the Environment. He is still committed to this proposal; I saw him recently and we had quite a long chat about the way in which this has progressed.

The Hon. Dr B. P. V. PEZZUTTI: I think we may be at cross-purposes.

Dr REFSHAUGE: I think we may be.

The Hon. Dr B. P. V. PEZZUTTI: This says that they will be employed to co-ordinate and manage the Aboriginal land claims process.

Dr REFSHAUGE: Yes, they are registrar processes.

The Hon. Dr B. P. V. PEZZUTTI: Not land claims under the Act?

Dr REFSHAUGE: Yes, they are land claims under the Act.

The Hon. Dr B. P. V. PEZZUTTI: Do you expect that there will be a lot more land claims?

Dr REFSHAUGE: No.

The Hon. Dr B. P. V. PEZZUTTI: What will these extra people do?

Dr REFSHAUGE: As I said, it is the Aboriginal Ownership Act. The registrar's role will include specific duties.

The Hon. Dr B. P. V. PEZZUTTI: So they will not be there for the Aboriginal land claims process, as stated in the budget paper?

Dr REFSHAUGE: They are for that and for Aboriginal ownership. Of course, you have to realise there was also a review of the Land Rights Act, and they had a significant input.

The Hon. HELEN SHAM-HO: I refer to Budget Paper No. 3, Volume 2, page 508, line item "Activities". How much did the Department of Aboriginal Affairs spend on community consultation and policy advice for the Aboriginal communities development program? How was this spending justified when a similar program was previously in existence?

Dr REFSHAUGE: A lot of the work was done by officers who already had substantive positions. In that sense I do not think that it would be possible to identify a specific amount that was set aside for consultation. A whole range of consultation processes are occurring. Issues that are being consulted upon, including this program, have not been finalised, such as the sites where it should be established. Some work was done in the predecessor program, the pilot program, but consultation is not just a matter of talking to the Aboriginal communities throughout New South Wales. Once a particular community has been identified as being part of this program, there is ongoing consultation with it. That consultation does not stop until the project is finished. A significant amount of consultation is factored into the program.

The Hon. HELEN SHAM-HO: In that case, can you explain how one person employed for community consultation could be regarded as adequate?

Dr REFSHAUGE: Consultation is not undertaken by one person. Automatic consultation occurs with a whole range of people, but it is important to have someone co-ordinate that consultation.

The Hon. HELEN SHAM-HO: You are saying that the person in your budget paper for community consultation is -

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Dr REFSHAUGE: It is an extra member to oversee consultation. That is the department's role in the consultation.

The Hon. HELEN SHAM-HO: So you are looking at funding -

Dr REFSHAUGE: In the future, yes, but I would hasten to add that the consultation is constant and ongoing and is not dependent on one person's salary. It is happening at a whole range of levels with a whole range of people involved in all aspects of it.

The Hon. Dr B. P. V PEZZUTTI: A moment ago you referred to the review of the Aboriginal Land Rights Act. When will that review commence? What is the purpose of that review? When will it finish? How much money is allocated to it?

Dr REFSHAUGE: First, the legislation requires that it be reviewed. Second, as a result of the request by the New South Wales Aboriginal Land Council and individual land councils, and as a result of the recommendations of ICAC's discussion paper, we are keen to do a comprehensive review, rather than just look at it and say that it seems basically fine. A lot of suggestions have been coming in. We are about to formally seek submissions for it, but we have had significant informal discussions with a number of interested groups, including the New South Wales Aboriginal Land Council. The cost of a review is about $250,000.

The Hon. Dr B. P. V. PEZZUTTI: Where is that identified in the budget? Is it in the budget papers?

Dr REFSHAUGE: I do not think it is identified as a budget item, but it is part of the cost of running the Department of Aboriginal Affairs. I am keen to ensure that we do not short-cut the consultation but, on the other hand, that we do not have consultation forever and get no result. At the moment I have not determined a closing date for this.

The Hon. HELEN SHAM-HO: I refer the Minister to Budget Paper No. 3, Volume 2, page 480. What measures are being taken to ensure that the program formerly known as the Aboriginal employment strategy will meet the differing needs of each community? What measures are in place to ensure that trainee health workers are suitably trained for these community needs? Do you have a benchmark system to determine the success of the program?

Dr REFSHAUGE: The training of Aboriginal health workers, as I have indicated, is often done by a number of different agencies that have their own standards and are outside my influence or control because they are professional bodies -

The Hon. HELEN SHAM-HO: But do you monitor and measure them?

Dr REFSHAUGE: Some have external control and assessment by TAFE or accreditation processes by appropriate tertiary institutions or tertiary boards. In that sense, the determination about skills development and requirements for graduating from them is an external review of sorts. The monitoring of the work is part of the responsibility of the managers and the CEOs of the area. They must ensure that the work they are being asked to do is being done, and is being done effectively. Obviously, it is outside the ability of one person to make the change required in respect of a number of issues facing Aboriginal communities. That is why the Aboriginal communities development program, which has been established through the Department of Aboriginal Affairs, is such an important program. It brings together a whole range of government agencies so that they are part of the process. There has been a major change compared to what happened in the past: the local community is a major determinant of what is done, how it is done and where it is done.

The Hon. HELEN SHAM-HO: I refer to Budget Paper No. 3, Volume 2, page 506, Operating Statement, line item "Grants and subsidies". Assistance to Aboriginal funding has decreased by $44.7 million, going from $1.308 million in 1997-98 to $816,000 in 1998-99. How will this reduction help address the inequity between opportunities for Aboriginal Australians and non-Aboriginal Australians?

Dr REFSHAUGE: If you look at the column before that, you will see that the budget was $308,000. The $1 million extra in the revised budget is a transfer from the Health Department to the Department of Aboriginal Affairs for the environmental health infrastructure project, so the health contribution would increase that. That project is coming to an end, which is why the budget for this year shows a reduction. However, as you see elsewhere, the $200 million over seven years starts to cut in and it increases significantly. As you said, it should make a big difference and I hope it will.

The Hon. HELEN SHAM-HO: The budget allocation for Aboriginal land rights capital grants decreased actually by $31,412 from $44,412. Why has there been a reduction? How will this funding cut enhance the ability of Aborigines to acquire land for
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their use and achieve a measure of independent support?

Dr REFSHAUGE: This is the legislative requirement that 7.5 per cent of land tax is paid into the New South Wales Aboriginal Land Council. If you are suggesting it should increase, you would be arguing effectively for an increase in land tax values. I have never heard you say that you want to increase land taxes.

The Hon. Helen SHAM-HO: No.

Dr REFSHAUGE: If the land tax were increased, the council would receive more money. I am happy to take on board your endorsement for an increase in land tax.

The Committee proceeded to deliberate on the recommendation of the vote.

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