23 November 2011
of the Legislative Council
HEALTH ORGANISATIONS BILL 2011 (No. 58)
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
the author, Dr Roger Wettenhall, makes this observation about the
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'.
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.
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.
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.
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.
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:
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.'
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.
the State Health minister told the House of Assembly, Madam
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'.
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.
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:
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.'
summary of the National Health Agreement says virtually the same
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.
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.
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.
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.'
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.
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.
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.
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
FINCH - Now there is a
point, yes. The most hated man in Tasmanian football -
PRESIDENT - Order. That
is totally irrelevant to the debate.
FINCH - Yes, you are
right. I should not respond. Thank you, Madam President