Wednesday 23 November 2011

Hansard of the Legislative Council


Mr FINCH (Rosevears)) - This bill, Madam President, sets in legislation the three regional health services which many Tasmanians, particularly in northern Tasmania and my electorate, have been wanting for many years. I say particularly northern Tasmania because the north has a special attachment to the Launceston General Hospital and its history of independence. In what in 1968 was a key reference and teaching resource, A Guide to Tasmanian Government Administration, the author, Dr Roger Wettenhall, makes this observation about the LGH:

'Unlike the Hobart General, however, the LGH was immediately placed under local control, thus initiating the system of hospital management that has, in essentials, continued to the present day in Tasmania'.

It is therefore not surprising, Madam President, that the feeling about the ownership of the LGH is strong in my community. Comments by the former State Minister for Health and now the Premier have focused on the creation of the area health services, the streamlining of accountability arrangements with the area CEOs reporting to the secretary, integrated service delivery and planning across an area, improved communications and the delegation of decision-making the most appropriate level as close to the patient as possible.

I cannot stress too much that last sentence - the delegation of decision-making to the most appropriate level as close to the patient as possible. These objectives are reflected in the Tasmanian Health Plan and associated documents as well as in the Department of Health and Human Services' Strategic Directions.

An important element of the health plan was integration of primary and acute care to, among other things, make it easier for patients to move between the two. Integration of health care and local management are at the core of the three area health services that have been operating for several years. The Northern Area Health Service was formerly created on 1 July 2009. It is the combination of the LGH and Primary Health North with each maintaining its pre-existing management and reporting structures and the LGH Executive - LEX - being expanded to include primary health and then inviting mental, oral and public health senior staff to attend meetings as observers. The fortnightly LEX meetings, usually chaired by the CEO of the Northern Area Health Service, John Kirwan, are attended by senior clinicians, the Director of Nursing, primary health and allied health executives and others. The separation of the LGH from the NAHS is planned but has been delayed for a range of reasons. Now if the THOs are approved that will not be needed.

The CEO of the LGH was pointed as the CEO of the NAHS and performs both roles. Resources transferred from the Department of Health and Human Services to the NHAS include pre-existing northern-based staff in human relations, primary health and finance. Prior to the creation of the area model, the acute sector was run by the Department of Health and Human Services, the CEOs reported to the Deputy Secretary and due to previous decisions, corporate support services were centralised with most staff based in DHHS and physically located in Hobart. This caused regional resentment. Hobart was seen as out of touch with the regions. The Northern Area Health Service has led to greater efficiency and improved patient experience, the ability to provide non-acute health needs closer to home and many other benefits.

The model is now firmly entrenched and the northern community would not give it up without a bitter fight. The creation of the Tasmanian health organisations is the next logical step after the three area health services. As the minister put it in her second reading speech:

'The creation of the THOs will result in increased local decision-making and greater clinician engagement. The creation of Area Health Services a few years ago began the journey of devolving decision-making to the local level, and the establishment of THOs is the next logical step.'

Of course, Madam President, the THOs fit with Commonwealth thinking. Both the present Prime Minister and her predecessor have endorsed local management of integrated health services during visits to the LGH. Three local health organisations in Tasmania is also the expressed policy of the Commonwealth Health Minister, Nicola Roxon.

As the State Health minister told the House of Assembly, Madam President:

'In August 2011 Tasmania reached an agreement with the Commonwealth, along with all States and Territories, to implement national health reform through the National Health Reform Agreement. These reforms will deliver more resources and better health and hospital services for Tasmanians, along with greater local control, greater efficiency and improved responsiveness'.

Madam President, this bill establishes the three Tasmanian health organisations as independent statutory authorities as is required by the National Health Agreement I referred to before. The Government, as we have heard in the briefing, has drawn heavily on the structure of government business enterprises in creating the THOs.

There appears to be some confusion in the public mind about how Federal funding will be delivered to the Tasmanian health organisations. However, there is no need for any confusion. If I can quote the State Health minister again:

'As part of the new reforms a national funding pool and administrator will be established which will distribute funds to THOs. This will make funding of healthcare services more transparent, ensuring that money committed to health services is only spent on those services.'

A summary of the National Health Agreement says virtually the same thing:

'Hospital funding will be provided through a single National Health Funding Pool. Payments will be made through this funding pool directly to Local Hospital Networks, using a nationally consistent approach to activity based funding.

The National Health Reform Agreement will create an Independent Hospital Pricing Authority (IHPA) to set the efficient price of delivering hospital services. This national activity based funding system will ensure that hospitals are paid according to the number and type of services they actually deliver - no more blank cheques.

The National Health Funding Pool will be established in 2012 and overseen by an Administrator, who will be independent from Commonwealth and state and Territory government departments.

These arrangements will greatly improve transparency and accountability of current health funding arrangements, under which the Commonwealth writes each state and territory a cheque, without knowing where the money goes or what services it funds.'

It could not be clearer, Madam President. Commonwealth funds will go directly to the three Tasmanian health organisations according to the number and type of services they actually deliver. This would seem to obviate the argument that the three organisations will be competing for Federal funds. I have spoken about the northern Tasmanian communities' identification and their ownership of the Launceston General Hospital. These sentiments have extended to the Northern Area Health Service since its inception.

Madam President, each of the three health regions is different. The one-size-fits-all approach has never and never will work. Some think that a central, single Tasmanian health organisation inevitably dominated by the south will save set-up costs and running costs. I would argue that set-up costs and running costs will come from reducing the DHHS and stopping duplication, and that was made explicit by Kevin Rudd when he was Prime Minister.

Madam President, the Department of Health and Human Services - DHHS - is the largest employer in Tasmania. It needs regional management. It is just too big to be run centrally from Hobart. I do not speak for all Tasmanians but this bill delivers the kind of local health organisation that the northern Tasmanian community has long argued for. Once the THOs are in place any government attempting to recentralise the Tasmanian health system does so at its peril. I strongly support the three Tasmanian health organisations to be established and I strongly support this bill.

Mr Harriss - Just before you sit down - through you, Madam President - if there was to be one structure you could probably ditch the parochialism and Scott Wade as a CEO.

Mr FINCH - Now there is a point, yes. The most hated man in Tasmanian football -

Madam PRESIDENT - Order. That is totally irrelevant to the debate.

Mr FINCH - Yes, you are right. I should not respond. Thank you, Madam President