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Legislative Assembly for the ACT: 2004 Week 06 Hansard (Tuesday, 22 June 2004) . . Page.. 2334 ..

Clearly, according to this group of people, it’s obvious there is a concern across the health sector that the Commonwealth-state split in health-care funding and responsibilities is not the best arrangement. Recent research commissioned by the Bracks Victorian government seems to be putting the same view.

Particular issues we face here in Canberra include the shortage of bulk-billing GPs and out-of-hours primary health care. I think it’s also inarguable—and it comes across in any conversations with health professionals—that the reduction of access to primary health care is obviously a factor in hospital overload. It’s a tragedy of course because it means that the human cost of that neglect and deficit is considerable and is putting pressures on hospitals, resulting in the consequent costs and political debate such as we’re having today. So I think it’s really important, in any discussion about hospitals, that you recognise that prevention and primary health care have to be seen within this context.

I think it’s unfortunate that we abandoned the community health centre model that flourished in the 1970s and early eighties. Such a model, of course, was made particularly difficult to manage, because, again, of the Commonwealth-state funding split.

There are also problems related to that split in regard to aged care. In very many ways, older people nowadays spend more time and money in hospital and on medical and life support. That is partly because prognosis and medical intervention are better, people survive various conditions and diseases and lead healthier and longer lives. It’s also true that, the more individuated lives that people lead in our society, they generally require more professional or community support and can depend less on informal family networks.

The point I’m making is that a system which makes the transition from home to supported accommodation to hospital and back again unwieldy or expensive does not meet our needs. We are all aware of the stories of older people in hospital, when they should be looked after in some kind of step-down facility, and a shortage of beds because there is nowhere more appropriate for such patients. We need to better integrate these services. Partly, the problem again lies in the cost-shifting pressures that exist between Commonwealth and states and territories. Partly the problem comes from lagging behind in our planning of facilities and services.

The other end of the journey, of course, is maternity services. We do embrace the medicalised model which, for healthy women, results in a less satisfactory, less healthy and more resource-intensive birthing experience than midwife-based care. We’ve obviously had a full report into that issue in the Legislative Assembly recently.

I was disappointed to see Calvary Hospital come out so strongly against the recommendations in our report. They seem to be taking this as some threat to them. In fact, it was actually a sensible look at the realities for a jurisdiction of the size that we are and at the need to look at inefficiencies and problems that can come from duplication which is not necessary. The unanimous view of the committee was that we needed to take a more holistic approach to providing maternity services to women in the ACT, and the Calvary Hospital, as I said, seemed to interpret this as a threat to their independence.

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