Page 2743 - Week 09 - Thursday, 26 August 1993
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MRS CARNELL (Leader of the Opposition) (11.41): This report was put together over a quite long period, and obviously the problems of financial management in Health have been with us for the whole time, in this Assembly as well as in the last Assembly. Mr Kaine and Ms Ellis have made some valid comments about the progress made in ACT Health, and there is no doubt that ACT Health has changed quite a lot. It has changed to the extent that we now have a capacity to allocate costs to cost centres. That is a huge change. But, unfortunately, the problem is that we then have absolutely no capacity to allocate costs from cost centres to services. When we spoke to senior health officials, they admitted that at this stage in the ACT we have absolutely no idea what services cost, in almost all circumstances.
Back in 1990, when I first went onto the Board of Health, we were told that in 1991 this would be fine; in 1991 we would know what services cost and therefore budgeting could be done appropriately. We were told by senior health officials that now it will be 1994, and I think the report says that we need to look at it again next year to see whether 1994 really is the year. It is exceedingly difficult to budget in health if you do not know what your services are costing. If you do not know what your adult dental services cost, it is very hard to decide on how much you will provide, how many staff you need, whom you can cover by the service. All you can possibly do is what ACT Health does at the moment, and that is budget from the top down. You say, "There is this amount of money. After you have spent it, that is the end of it". The inevitable consequence of that is that you end up budgeting by waiting list. That is not an appropriate way to budget, and I think that was brought out time and time again when we were putting this report together.
Mr Berry interjected earlier and said, "But who can produce these figures?". Cost attribution can be done in virtually every State in Australia now. Even Yass Hospital can organise cost attribution for all of their services. Every hospital in New South Wales is involved in cost attribution, as are Victoria and Queensland, and the story goes on. It seems remarkable to me that after all this time, when we have only two hospitals in the ACT and only one under our direct control, we have not managed to achieve what States such as New South Wales, with all the problems they have in their health service generally, have managed to achieve.
We have a huge number of new systems and we have a large number of people who have now been trained to run those systems, but the capacity to coordinate the stunning amount of information that is coming out of Health seems to be somewhat lacking. I think Mr Kaine rightly made the comment that that runs through very much into the budget process. Senior health officials told us quite categorically that they can predict what the activities levels will be for next year, as they could have for this year. The public-private mix situation has been trending in an almost straight line over the past few years, so it is certainly not very hard to work out what will happen in terms of public-private mix.
It is interesting that in the budget supplementary papers last year a prediction was made, but unfortunately that prediction was not put forward into the budget estimates. A budget has to be exactly that - a budget. It has to be an anticipation of the money that will be needed in a particular area to run a particular service.
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