Ms MARTIN - 1999-02-17
As health minister, or in his current role, has the Chief Minister spoken to the federal government about his agenda to privatise all our public hospitals? Can the Chief Minister table any cast-iron, written guarantee from the federal government that it will not reduce any Territory funding as a result of his agenda to have Territorians ...
Mr Coulter: When was the last time you could get that out of the federal government of either political persuasion?
Ms MARTIN: ... to up-front fees or health insurance premiums?
Mr BURKE: Could you repeat the last part of the question - I missed it.
Ms MARTIN: If Barry would be quiet.
Mr Coulter: Well, when could you ever get a cast-iron guarantee out of the federal government of any political persuasion?
Mr SPEAKER: Order!
Ms MARTIN: For the Chief Minister, I will repeat the second half of the question. Can the Chief Minister table any cast-iron, written guarantee from the federal government that it will not reduce any Territory funding as a result of his agenda to have Territorians pay for hospital care through up-front fees or health insurance premiums?
ANSWER
Mr Speaker, the simple answer to the question is that this exercise has been gone through, with Commonwealth cooperation, in Victoria, New South Wales, Queensland, Western Australia and South Australia. In terms of a direct question and meeting with the federal Minister for Health, I had arranged that for last Friday but events overtook that meeting. I have since arranged for our current health minister to go down and speak to the federal Minister for Health about these matters and also about another pressing matter - Aboriginal funding in central Australia.
In terms of the concern of the Commonwealth, the simple answer to your question gets back to the core of the issue here. We are not talking about a wholesale sell-off of our public hospitals. We are talking about a different management regime, as one option. The responsibility for public hospitals remains presently with the Northern Territory government and will always remain with the Northern Territory government. The guarantees that the Commonwealth would require under the Australian Health Care Agreement would be maintained, firstly, under the Health Care Agreement and, secondly, through the contractual arrangements with a private provider, if that were the case. I might add that if there were any corporatisation options which involved an in-house change of structure, a similar situation would have to exist.
The Commonwealth and the Northern Territory governments are interested primarily in one thing - the preservation of the Australian Health Care Agreement. Everyone should understand that the fundamental of that agreement is that all Australians, regardless of their income, have free access to public hospitals, and that free access is only determined on clinical need. That is the crux of the matter. There is no intent, and will never be any intent, by the Northern Territory government to change that fundamental, because we subscribe to it and believe in it completely.
More than that, we want to improve it. We want to get access to clinical care for those in need, with a range and quality of care that truly services Territorians and leads us into the next century as a state. There are degrees of morbidity that cannot be dealt with in the Northern Territory. We have a burdensome health system which is totally funded by the Northern Territory government and also the Commonwealth through the Health Care Agreement. I might add that the Commonwealth contribution is $90m of the total $180m cost at the moment, rising by about $10-$15m per year, with a downstream cost in structural changes to our hospitals which adds up to some $200m in the near future. There are pressing issues that have to be addressed. There is no private system that can exist in the Northern Territory in the current structures that we have at the moment.
Notwithstanding what we do, the current health system in the Northern Territory will never be the same again. It won’t be the same because it simply has to change. This government cannot afford to maintain a public system that is 50% funded by the Northern Territory government in the face of reducing funding from the Commonwealth. One of the reasons that reducing funding occurs is because there is an expectation from the Commonwealth that we will have a robust private health sector that will save the Commonwealth some of the funds they currently spend. That is one of the methods they use to hold funding back from us, and I do hope the opposition at least understands the fundamental factors for why we are going through this exercise
We have a burdensome public health system that is suffocating any ability for the private health system to get involved. Because of the remoteness and the way we have to deliver services in the Northern Territory, there is no equity in the system. A person in Alice Springs cannot access the same equity of care as a person in Tennant Creek or a person in Darwin. We have to get structural equity into the system. We have to get better coordination of our efforts so that we can get true co-location of private and public facilities. Lastly, there are some efficiencies to be gained. I have said, on every occasion that I have been asked, that the efficiency factor in terms of effect on staff is almost a ‘no consideration’ in my view. This is because the consultant’s report, which I have put out to the public sector for everyone to read, says that plainly. It says: ‘Your hospitals are efficient, but you have these structural problems that have to be addressed’.
I would have thought that any responsible government should go down the path that we’re going. We have the best consultants in Australia in Health House.
Ms Martin interjecting.
Mr BURKE: No, you should listen to this, Leader of the Opposition, because if you want a briefing , you can get a briefing. These are some of the best consultants in Australia who have been through this exercise in other jurisdictions. Indeed, in other jurisdictions, such as Mildura, they have said: ‘Stop, this is not good for government, don’t go forward with it’. The same people are there now. They are supported by well-intentioned public servants who are working through the cost-benefit analysis to ensure that we get the best result for the Northern Territory, or we won’t go down that path.
That is the responsible thing for a government to do. It is trying to lower the cost to Territory taxpayers. It is trying to move more dollars from the acute sector into the primary health care sector, which is crying out for more money. We know from our own experience that that is the real area of improvement. To suggest that we shouldn’t go down this path, at least to the point we are going through in the initial exercise, is flat irresponsible.
Mr Coulter: When was the last time you could get that out of the federal government of either political persuasion?
Ms MARTIN: ... to up-front fees or health insurance premiums?
Mr BURKE: Could you repeat the last part of the question - I missed it.
Ms MARTIN: If Barry would be quiet.
Mr Coulter: Well, when could you ever get a cast-iron guarantee out of the federal government of any political persuasion?
Mr SPEAKER: Order!
Ms MARTIN: For the Chief Minister, I will repeat the second half of the question. Can the Chief Minister table any cast-iron, written guarantee from the federal government that it will not reduce any Territory funding as a result of his agenda to have Territorians pay for hospital care through up-front fees or health insurance premiums?
ANSWER
Mr Speaker, the simple answer to the question is that this exercise has been gone through, with Commonwealth cooperation, in Victoria, New South Wales, Queensland, Western Australia and South Australia. In terms of a direct question and meeting with the federal Minister for Health, I had arranged that for last Friday but events overtook that meeting. I have since arranged for our current health minister to go down and speak to the federal Minister for Health about these matters and also about another pressing matter - Aboriginal funding in central Australia.
In terms of the concern of the Commonwealth, the simple answer to your question gets back to the core of the issue here. We are not talking about a wholesale sell-off of our public hospitals. We are talking about a different management regime, as one option. The responsibility for public hospitals remains presently with the Northern Territory government and will always remain with the Northern Territory government. The guarantees that the Commonwealth would require under the Australian Health Care Agreement would be maintained, firstly, under the Health Care Agreement and, secondly, through the contractual arrangements with a private provider, if that were the case. I might add that if there were any corporatisation options which involved an in-house change of structure, a similar situation would have to exist.
The Commonwealth and the Northern Territory governments are interested primarily in one thing - the preservation of the Australian Health Care Agreement. Everyone should understand that the fundamental of that agreement is that all Australians, regardless of their income, have free access to public hospitals, and that free access is only determined on clinical need. That is the crux of the matter. There is no intent, and will never be any intent, by the Northern Territory government to change that fundamental, because we subscribe to it and believe in it completely.
More than that, we want to improve it. We want to get access to clinical care for those in need, with a range and quality of care that truly services Territorians and leads us into the next century as a state. There are degrees of morbidity that cannot be dealt with in the Northern Territory. We have a burdensome health system which is totally funded by the Northern Territory government and also the Commonwealth through the Health Care Agreement. I might add that the Commonwealth contribution is $90m of the total $180m cost at the moment, rising by about $10-$15m per year, with a downstream cost in structural changes to our hospitals which adds up to some $200m in the near future. There are pressing issues that have to be addressed. There is no private system that can exist in the Northern Territory in the current structures that we have at the moment.
Notwithstanding what we do, the current health system in the Northern Territory will never be the same again. It won’t be the same because it simply has to change. This government cannot afford to maintain a public system that is 50% funded by the Northern Territory government in the face of reducing funding from the Commonwealth. One of the reasons that reducing funding occurs is because there is an expectation from the Commonwealth that we will have a robust private health sector that will save the Commonwealth some of the funds they currently spend. That is one of the methods they use to hold funding back from us, and I do hope the opposition at least understands the fundamental factors for why we are going through this exercise
We have a burdensome public health system that is suffocating any ability for the private health system to get involved. Because of the remoteness and the way we have to deliver services in the Northern Territory, there is no equity in the system. A person in Alice Springs cannot access the same equity of care as a person in Tennant Creek or a person in Darwin. We have to get structural equity into the system. We have to get better coordination of our efforts so that we can get true co-location of private and public facilities. Lastly, there are some efficiencies to be gained. I have said, on every occasion that I have been asked, that the efficiency factor in terms of effect on staff is almost a ‘no consideration’ in my view. This is because the consultant’s report, which I have put out to the public sector for everyone to read, says that plainly. It says: ‘Your hospitals are efficient, but you have these structural problems that have to be addressed’.
I would have thought that any responsible government should go down the path that we’re going. We have the best consultants in Australia in Health House.
Ms Martin interjecting.
Mr BURKE: No, you should listen to this, Leader of the Opposition, because if you want a briefing , you can get a briefing. These are some of the best consultants in Australia who have been through this exercise in other jurisdictions. Indeed, in other jurisdictions, such as Mildura, they have said: ‘Stop, this is not good for government, don’t go forward with it’. The same people are there now. They are supported by well-intentioned public servants who are working through the cost-benefit analysis to ensure that we get the best result for the Northern Territory, or we won’t go down that path.
That is the responsible thing for a government to do. It is trying to lower the cost to Territory taxpayers. It is trying to move more dollars from the acute sector into the primary health care sector, which is crying out for more money. We know from our own experience that that is the real area of improvement. To suggest that we shouldn’t go down this path, at least to the point we are going through in the initial exercise, is flat irresponsible.
Last updated: 09 Aug 2016