Page 2373 - Week 08 - Wednesday, 29 August 2007
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DR FOSKEY: These costs need to be laid against perceived benefits, and we need to consider more than the bottom line in so doing. I hope that the current one-upmanship demonstrated by the major parties contesting the federal election is allowed to morph into a real debate on the kind of health system which will be most effective in delivering the best health outcomes for Australians at an affordable price for all.
I am not sure whether it is a good idea for the commonwealth to take over hospitals, as Abbott has been threatening and now Rudd promises. I think that when it comes to the point, not too many federal governments would welcome the inevitable criticism that comes with hospital administration. I do wonder if hospitals need to be as big as they are becoming. At what point are efficiencies of scale lost to the complex, unwieldy machine needed to run the giant hospitals which are a feature of our cities? I would like to see that cost-benefit analysis.
I do believe that we should always be seeking to reduce the number of people needing treatment at the acute end of the health system. The Greens believe that a greater emphasis on primary health care is a major means for achieving this. The Liberals do not make clear what they mean in their dissenting remarks to the estimates report by a one-stop shop. Perhaps they mean something like the community health centres which used to service many of our suburbs. While these still exist in a more centralised form, they now focus on people on pensions and other Centrelink payments, whereas once they were resourced to service a broader range of patients. The Greens would like to see the development of community centres with medical and allied health care in ready reach of public transport.
Achieving health outcomes requires a whole-of-government approach. A healthy city with healthy residents would be one that gives residents plenty of opportunities to walk and cycle. Canberra has plenty of these places, but it is nonetheless much easier to do most things, go to work and school, shop and visit people and places, by car. This was one of my criticisms of the school closures: many children would lose the opportunity to walk or ride to school. It is a reason why the Greens are so opposed to the loss of local shopping centres. Having to put the bike on the car or drive to the gym is a contradictory way of keeping healthy.
Similarly, participation in sport provides a number of benefits besides fitness, such as the development of friendships and the sense of belonging, as well as experience in team work and the excitement of competition. Maintaining public swimming pools and sports grounds is as much the business of the health minister as it is the minister for territories. I hope that the health minister is always consulted when rationalisation threatens the closure of such facilities.
Many health consumer organisations stress the need for good services to back up people remaining in their homes—those that have one. The support would vary from minimal to more complex services. One woman I know, who has multiple sclerosis, told me that what would make the difference between her remaining in her home or going into care would be the simple thing of help taking out her rubbish bin every week. There was a strong call from the mental health consumer advocates, and the minister indicated that she shared this vision. I will read Ms Gallagher’s comments. Page 102 of the estimates report states:
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