SENATE Official Committee Hansard · answer a question to assist the Hansard reporters. Minister,...

COMMONWEALTH OF AUSTRALIA

PARLIAMENTARY DEBATES

SENATE

Official Committee Hansard

COMMUNITY AFFAIRS LEGISLATIONCOMMITTEE

(Consideration of Estimates)

TUESDAY, 19 AUGUST 1997

BY AUTHORITY OF THE SENATECANBERRA 1997

CONTENTS

TUESDAY, 19 AUGUST

Department of Health and Family Services—Program 1—Public Health—

Subprogram 1.1—Public Health Development and Programs. . . . . 86Subprogram 1.2—Health Regulation. . . . . . . . . . . . . . . . . . . . . . 125Subprogram 1.3—Health Research and Information. . . . . . . . . . . 142

Program 2—Health care and access—Subprogram 2.1—MedicalBenefits and General Practice. . . . . . . . . . . . . . . . . . . . . . . . . . . 147

Program 2—Health Care and Access—Subprogram 2.1—Medical Benefits and General Practice. . . . . . . . 149Subprogram 2.2—Pharmaceutical benefits. . . . . . . . . . . . . . . . . . 155Subprogram 2.3—Acute care. . . . . . . . . . . . . . . . . . . . . . . . . . . 171Subprogram 2.4—Mental Health. . . . . . . . . . . . . . . . . . . . . . . . . 180

Program 3—Aboriginal and Torres Strait Islander Health. . . . . . . . . 182Program 4—Family and children’s services—

Subprogram 4.1—Children’s services. . . . . . . . . . . . . . . . . . . . . 192Subprogram 4.2—Family services. . . . . . . . . . . . . . . . . . . . . . . . 210

Program 5—Aged and community care—Subprogram 5.1—Community care and support for carers. . . . . . . 213Subprogram 5.3—Residential access and quality. . . . . . . . . . . . . . 214

Program 6—Disability Programs—Subprogram 6.1—Employment Assistance. . . . . . . . . . . . . . . . . . 232Subprogram 6.2—Commonwealth Rehabilitation Service. . . . . . . . 234Subprogram 6.3—Commonwealth/State disability agreement. . . . . 235Subprogram 6.4—Access and participation. . . . . . . . . . . . . . . . . 236

Program 7—Corporate leadership and management—Subprogram 7.2—Corporate services. . . . . . . . . . . . . . . . . . . . . . 237Subprogram 7.3—Information Services. . . . . . . . . . . . . . . . . . . . 238

Tuesday, 19 August 1997 SENATE—Legislation CA 83

SENATE

Tuesday, 19 August 1997

COMMUNITY AFFAIRS LEGISLATION COMMITTEE

Portfolios: Health and Family Services; Social Security

Senators in attendance:Senator Knowles(Chair), Senators Calvert, Coonan, Denman,Eggleston, Forshaw, Gibbs, Harradine, Heffernan, Neal, Patterson, Synon and West

The committee met at 9.05 a.m.

DEPARTMENT OF HEALTH AND FAMILY SERVICESProposed expenditure, $2,879,850,000 (Document A).Proposed provision, $1,539,755,000 (Document B).

In AttendanceSenator Herron, Minister for Aboriginal and Torres Strait Islander AffairsExecutive

Professor Judith Whitworth, Chief Medical OfficerMs Mary Murnane, Deputy SecretaryMr Ian Lindenmayer, Deputy Secretary

Program 1—Public HealthPublic Health Division

Ms Liz Furler, First Assistant SecretaryDr Margaret Dean, Medical AdviserDr Cathy Mead, Assistant Secretary, National Centre for Disease ControlMs Jan Bennett, Assistant Secretary, Planning BranchMr David Marcus, Assistant Secretary, National Centre for Disease ControlMs Sue Kerr, Assistant Secretary, National Health Promotion and Protection BranchMr Roger Hughes, Director, National Drug Strategy, National Health Promotion and

Protection BranchMr Jamie Fox, Director, Tobacco & Alcohol Strategies Section, National Health Promotion

& Protection BranchMs Laurie Van Veen, Director, Public Health Education Unit, National Centre for Disease

ControlMr Mark Cooper-Stanbury, Director, Public Health Information Unit, Planning BranchMr Brendan Gibson, Director, Evaluation Unit, Planning Branch

Mr Steve Lowes, Director, Business UnitMr Tom Carroll, Senior Adviser, Research & Monitoring

Therapeutic Goods Administration

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CA 84 SENATE—Legislation Tuesday, 19 August 1997

Mr Terry Slater, National ManagerMs Ngaire Bryan, Director, Business and ServicesDr Susan Alder, Director, Drug Safety & EvaluationDr John Cable, Director, Conformity AssessmentMr Andrew Wood, Director, Chemicals & Non Prescription Drug BranchMr Brian Priestly, Scientific Director, Chemicals & Non Prescription Drug Branch

Australian Institute of Health and WelfareMr Geoff Sims, Head, Health Division, Australia New Zealand Food AuthorityMs Winsome McCaughey, ChairpersonMr Graham Peachey, General ManagerDr Gordon Burch, Scientific & Technical Manager

Office of the National Health and Medical Research CouncilMr Robert Wells, Acting First Assistant SecretaryDr Cindy Wong, Assistant Secretary, Health Intelligence and Partnerships BranchMr Richard Morris, Assistant Secretary, Health Research

Program 2—Health Care and AccessHealth Benefits Division

Ms Penny Rogers, Acting First Assistant SecretaryMs Gail Batman, Assistant Secretary, Medicare Benefits BranchMr Alan Stevens, Acting Assistant Secretary, Pharmaceutical Benefits BranchDr Vin McLoughlin, Assistant Secretary, General Practice BranchMr John Kilpatrick, Assistant Secretary, Diagnostics and Technology BranchMr Col Bailey, Assistant Secretary, Medicare Schedule Review Task ForceDr John Primrose, Medical AdviserMr Alan Keith, Assistant Secretary, Coordinated Care Branch, Professional Services ReviewMr Peter Dunnett, Executive OfficerDr John Holmes, Director, Health Services Development DivisionDr John Loy, First Assistant SecretaryMr John Evered, Managing Director, Health Insurance CommissionDr Harvey Whiteford, Director, Mental Health Branch, Health Insurance CommissionMs Jackie Wood, General ManagerMr Michael Whelan, Acting General Manager, Finance and PlanningMr Ralph Watzlaff, Acting General Manager, Professional Review

Program 3—Aboriginal and Torres Strait Islander HealthOffice of Aboriginal and Torres Strait Islander Health Services

Dr Ian Anderson, Acting First Assistant SecretaryMs Marion Dunlop, Assistant Secretary, Planning & EvaluationMr Joseph Murphy, Assistant Secretary, Program Development and Management

Program 4—Family and Children’s Services

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Mr Barry Wight, First Assistant SecretaryMr Richard Lansdowne, Assistant Secretary, Administration and Development BranchMs Margaret Carmody, Assistant Secretary, Policy Analysis and Planning BranchMr Ian McRae, Assistant Secretary, Subsidies & Financial ManagementMs Beth Grigson, Assistant Secretary, Family Services Branch

National Childcare Accreditation CouncilMs Denise Taylor, General ManagerMr Bruce Davie, Financial Controller

Program 5—Aged and Community CareMs Jenny Bryant, Assistant Secretary, Policy and Evaluation BranchMs Gail Yapp, Acting Assistant Secretary, Residential Program ManagementMr Brian Conway, Acting Assistant Secretary, Community Care BranchMr David Learmonth, Director, Strategic Development Section

Program 6—Disability ProgramsMr Warren Cochrane, First Assistant SecretaryMs Judy Blazow, Assistant Secretary, Strategic Management BranchMr Roger Barson, Assistant Secretary, Policy and Planning Disability Programs BranchMs Ruth Goren, Assistant Secretary, Office of Disability Health Services AustraliaPeter Fisher, Office of Hearing ServicesMr Paul McGlew, Acting Assistant Secretary, Australian Hearing ServicesMr Philip Bert, Managing Director

Commonwealth Rehabilitation ServiceMr Alan Law, General Manager

Program 7—Corporate Leadership and ManagementCorporate Services Division

Mr Neville Tomkins, First Assistant SecretaryMr John Carroll, Assistant Secretary, Legal ServicesMs Wynne Hannon, Legal ServicesMr Mark Johnson, Assistant Secretary, Financial ManagementMs Tricia Searson, Assistant Secretary, Public Affairs, Parliamentary and Access

Portfolio Strategies GroupMs Lynelle Briggs, First Assistant SecretaryMs Helen Evans, Assistant Secretary, Budget Information and EvaluationMr Gerry Linehan, Director, Budget Strategy

Information Services DivisionDr Ian Heath, First Assistant Secretary

Department of Finance

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Perry SperlingJoy PettingellDavid LindsayRichard LindsayJohn IgnatiusJoel SchirmerLawrence BourkeJay PottertonJenni LillingstonLouise ClarkeCHAIRMAN —I declare open this supplementary hearing of the Senate Community Affairs

Legislation Committee, considering the budget estimates for the portfolio of Health and FamilyServices. The committee has before it a list of the subprograms relating to matters whichsenators have indicated that they wish to raise at this hearing. In accordance with the standingorders relating to supplementary hearings, today’s proceedings will be confined to matterswithin the relevant subprograms.

I welcome the Minister representing the Minister for Health and Family Services, SenatorJohn Herron. Unfortunately the departmental secretary, Mr Andrew Podger, is ill and will notbe with us today. So Ms Mary Murnane, the deputy secretary, has agreed, thankfully, to fillin for him. So I welcome you, Ms Murnane, and I also of course welcome the officers fromthe department. Could I remind officers to clearly identify themselves when first called toanswer a question to assist theHansardreporters. Minister, do you have an opening statement?

Senator Herron—No, thank you.CHAIR —Thank you very much. The committee will commence with program 1.

Program 1—Public HealthSubprogram 1.1—Public Health Development and Programs

Senator FORSHAW—Thank you, Chair. Might I indicate at the outset that, whilst Iunderstand the comments you just made about the nomination of programs to be dealt withtoday, we did indicate that we would not require a couple of agencies—in particular, AustralianHearing Services, the Nuclear Safety Bureau and the Australian Childcare AccreditationCouncil—to travel from interstate here today for the purpose of answering only a couple ofquestions. But I envisage that there will be some questions placed on notice for some or allof those groups.

CHAIR —Thank you, Senator.Senator FORSHAW—I am sure you will be totally surprised, Minister, when I ask some

questions about the proposed—or maybe not proposed, depending upon the outcome of today’scabinet meeting—heroin trial. On the last occasion—and I appreciate that you were not theminister at the table on that occasion—a number of questions were asked about a proposedheroin trial. In particular, at page 85 ofHansardI asked this question:Has the minister indicated to the state ministers whether or not he supports the heroin trial in the ACT?

The answer from Ms Furler was:

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The minister agreed with his colleagues at the last MCDS meeting last year that he was still interestedin considering the possibility of a heroin trial in several states throughout Australia. He asked the NationalDrug Strategy Committee to set up a working group, which I described this morning. It has been busyconsidering the national implications of a heroin trial and it is due to report to MCDS in July this year.So our minister has indicated he is still interested, but he has made it very clear that there would needto be a broad base of support among all states and territories for that to occur.

Later on, Ms Furler and Mr Podger referred to the ministerial council being due to meet andthat, presumably at that next meeting, the views of the Premiers would be ascertained and thatthings may move from there. Could you give us an update as to what occurred at theministerial council meeting, which I understand took place in Cairns, and what was thedecision of the ministerial council on a proposed heroin trial?

Senator Herron—I will ask the officer.Ms Furler —Madam Chair, would you like me to read the resolutions on the heroin trial

for the MCDS?CHAIR —That would be helpful Ms Furler.Ms Furler —They run to two and a half pages.Senator FORSHAW—How much?Ms Furler —Two and a half pages.Senator FORSHAW—I am happy if you provide copies of them. Is it possible to summarise

them? If you want to read them out in full I am quite prepared to hear them as well.Ms Furler —The MCDS:

. Endorses a comprehensive, integrated approach to deal with the problems of use of illicit drugsincluding heroin in Australia, involving a balance between supply and demand reduction strategies.

. Agrees on the need for a national strategic approach to illicit drugs including heroin, including primaryprevention, with secondary and tertiary initiatives to minimise harm to individual users and the generalcommunity.

. Endorses a concerted national effort to develop a broad range of effective and evidence based treatmentoptions for people who are opioid dependent, as outlined in the report of the sub-committee on thecontrolled availability of opiods.

. Notes that the controlled availability of heroin is only one of a range of possible treatment modalitiesfor heroin dependence, and is unlikely to be more than a minor component of that range of options.

. Notes proposals for research and evaluation of the cost effectiveness of different treatment modalities,involving maintenance treatment, withdrawal treatment, and relapse prevention, including:- in Victoria, trials of oral morphine, Buprenorphine, LAAM and Naltrexone;- in New South Wales, trials of Buprenorphine and Naltrexone;- in South Australia, trials of Buprenorphine, LAAM, tincture of opium and Naltrexone;

In the ACT, trials of prescription heroin and Buprenorphine.. Notes the Commonwealth will continue to contribute to trials and to the coordination and evaluation

of a suite of different . . . modalities to ensure a concerted national effort in the development oftreatment options.

. Notes that a substantial amount of work is also underway to improve the effectiveness of Methadoneservices.

. Agrees on the establishment of a national expert advisory committee on illicit drugs, to include in itsterms of reference coordination of research undertaken throughout Australia, evaluation of outcomesof research activities, and identification of areas of deficiency, with the aim of developing best practicetreatment models.

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. Notes that the Australian Capital Territory is prepared to proceed with the first stage of the proposedheroin trial involving 40 participants with the support of Victoria, South Australia, Tasmania and NewSouth Wales. The trial will be informed by detailed information from the Swiss heroin trials includingthe evaluation by the World Health Organisation.

. Notes that the Commonwealth will make a contribution directed to evaluation and security aspects,with the Australian Capital Territory arranging funding of the Diacetylmorphine.

. Notes that the pilot will only proceed on the basis that:- Australia meets its international treaty obligations under the United Nations Single Convention on

Narcotic Drugs 1972 and the 1988 Convention Against Illicit Traffic in Narcotic Drugs andPsychotropic Substances.

- It is formally put to the International Narcotics Control Board and the Commission on Narcotic Drugsand is not opposed by the Board or by a majority of the members of the Commission.

. Notes that other jurisdictions, including the Commonwealth, accept the right of the Australian CapitalTerritory to proceed with the pilot within its jurisdiction as long as the international obligations aremet and it is not opposed by the International Narcotics Control Board or a majority of members ofthe Commission on Narcotic Drugs.

. Notes that the Australian Capital Territory intends to amend its trial design to:- Ensure compliance with relevant international conventions;- include withdrawal treatment and long term abstinence in the trial objectives;- introduce charges equivalent to those for methadone maintenance; and- take account of the World Health Organisation’s evaluation of the Swiss heroin trial, which is due

to be released in February 1998.. Notes that any decision to proceed to the second and third stages of the trial will be dependent upon

evaluation of the first stage.. While supporting a broad range of effective and evidence-based treatment options, and research and

evaluation of different treatment modalities, Queensland, Western Australia and the Northern Territoryoppose the proposed Australian Capital Territory’s heroin trial.

. Agrees to the printing and public dissemination as a national drug strategy publication, the report ofthe subcommittee on the controlled availability of opioids.

In fact, I read out those recommendations, they are not a summary.Senator FORSHAW—Thank you. The committee would appreciate a copy of what you

have read out, but obviously it will appear in theHansard. Just to go back over what you havesaid: Victoria, South Australia, Tasmania, New South Wales and the ACT, you indicated thatthey supported stage 1 of the trial? Did I hear correctly?

Ms Furler —It notes that the ACT is prepared to proceed with the first stage of the proposedheroin trial involving 40 participants, with the support of Victoria, South Australia, Tasmaniaand New South Wales.

Senator FORSHAW—That is correct. I think you indicated that the meeting also noted thatQueensland, the Northern Territory and Western Australia opposed the trial.

Ms Furler —Yes.Senator FORSHAW—Just before I go on, what was the date of the meeting?Ms Furler —It was 31 July.Senator FORSHAW—Have there been any subsequent meetings of the council?Ms Furler —No.Senator FORSHAW—What was the position of the Commonwealth at the meeting? Which

way did they vote? Did they support or not support—

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Senator Herron—My understanding of ministerial councils is that the Commonwealth doesnot have a vote.

Senator FORSHAW—Did they express a view? I am sure in these sorts of meetings peoplecould express their views. I would not want to make it as tawdry as a preselection ballot.

Senator Herron—Yes, I just wanted to clarify though, Senator Forshaw, that there is novote at ministerial councils. It is the ministerial council of the states and territories, and theCommonwealth attends.

Senator NEAL—It is generally done by consensus, isn’t it, rather than a vote?

Senator Herron—Yes, that is correct.

CHAIR —Senator Forshaw, the departmental officers would not have been at that meetingand I think I am right to say that Senator Herron was not at that meeting either, so to askwhether the Commonwealth expressed a view—

Senator FORSHAW—I think it is a reasonable question, Chair.

Senator Herron—What I am getting at is that I attend the others in relation to my ownportfolio. But there is no vote. There is a consensus arrived at by the chairman. TheCommonwealth attends but is not part of that council.

Senator FORSHAW—In the evidence that had been given to the estimates committee, MsFurler said, on behalf of the minister and the government, that the position of Dr Wooldridgewas that he was interested in considering the possibility of a heroin trial, but certainly a majorfactor in coming to a conclusion about whether or not the Commonwealth government wouldsupport it was the attitude of the states and territories.

The ministerial council meeting took place and the attitude of the states and territories wasconveyed. We had a majority of states and territories indicating that they supported stage 1of the trial going ahead in the ACT with 40 participants. What I am asking is, in all of this,surely the Commonwealth did not just sit there and leave it entirely dependent upon the viewsof the states as to what should occur.

Ms Murnane—Senator, I was not in the room when this was considered in Cairns, but Irecall that there were a number of interviews later. I cannot remember exactly what DrWooldridge said during those interviews, but we can find that and table it. But I think it isa matter for the record that he said that the Commonwealth was willing to support it, subjectto certain conditions being met, and those conditions would have to be tested by all parties—the Commonwealth and the states. Ms Furler identified those conditions before.

Senator FORSHAW—Would you repeat those conditions for me as to what was said thatthose conditions were?

Ms Furler —Those conditions had to do with Australia meeting its international obligationsand, in particular, they have to do with the treaty obligations under the United Nations SingleConvention on Narcotic Drugs 1972 and the 1988 Convention against Illicit Traffic in NarcoticDrugs and Psychotropic Substances, and that it is formally put to the International NarcoticsControl Board and the Commission on Narcotic Drugs and is not opposed by the board or amajority of the members of the commission.

Senator FORSHAW—I heard you say that earlier. Thank you for repeating it. Youindicated in reading out the resolutions that they also include reference to the Commonwealthproviding support, that is, financial support, in terms of at least two aspects: the costs ofsecurity and evaluation. This would seem to indicate that the Commonwealth, on the basis

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of, firstly, the majority attitude of the states and territories and, secondly, subject to the issueof these international obligations, at that stage was saying that they were prepared to get onboard and provide logistical and financial support for the trial. Do you agree with that?

Ms Furler —Yes, that is the usual role of the Commonwealth in these national initiatives.Senator FORSHAW—Do you have any estimate of what the cost of the trial would be?Ms Furler —Yes. It is estimated that the six-month trial will cost in excess of $800,000.

That comprises infrastructure of $125,000 for the establishment of secure clinic facilities; clinicstaff in the order of $450,000; running costs of $40,000; and research costs of $200,000.

Senator FORSHAW—That is stage 1, isn’t it?Ms Furler —Yes.Senator FORSHAW—What about stage 2 and 3; is there any estimate of costs for those?Ms Furler —All three stages of the trial were estimated by the working party to cost in the

order of $15 million.Senator FORSHAW—I note that in the figures that you gave me there is no mention of

the actual cost of the imported heroin in the break-up of $800,000 for stage 1. Could you tellme if there is an estimated cost for the imported heroin?

Ms Furler —I do not have an exact breakdown of the imported heroin cost, but I think therunning costs of $40,000 include the cost of prescription heroin, needles, syringes and swabs.

Senator FORSHAW—So that would be included in that figure?Ms Furler —As I understand it, yes.Senator FORSHAW—Could you check that?Ms Furler —Yes.Senator FORSHAW—I assume that means that it would also be included in the overall

costs of $15 million for stage 2 and stage 3, but I would like you to check that as well.Ms Furler —Yes.Senator FORSHAW—Could you indicate how much, or what proportion of the total cost,

would be attributable to the actual cost of the importation of the heroin. Could you take thatquestion on notice?

Ms Furler —Yes.Senator FORSHAW—Who was going to pay for the cost of the importation of the heroin?Ms Furler —I understand the ACT was going to pay for that.Senator FORSHAW—For stage 1?Ms Furler —Yes.Senator FORSHAW—Who would pay for the other stages?Ms Furler —I do not know. I imagine the details for stages 2 and 3 would be subject to a

successful outcome of the evaluation of stage 1. The costs and the obligations of the separatestakeholders to meet those costs would have to be negotiated at that stage.

Senator FORSHAW—I appreciate the point you are making. What interests me is: if stage1 was said to be successful and there was progression to stage 2 and 3—if the trials wentahead—it would be hard to imagine the ACT, for instance, picking up the further cost of theimported heroin, given the resources of the ACT government.

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I understand what you have said, that it is probably a matter for further negotiation. WhatI would like to know is: was any indication given by the Commonwealth as to it providingfinancial support or covering the cost of the importation of heroin in further trials?

Ms Furler —No, there was no discussion.

Ms Murnane—Although what Ms Furler says is absolutely correct, that the details of stages2 and 3 depend on an evaluation of stage 1, the actual purchase of the heroin in the ACT, orin any other state, would be the responsibility of the state.

Senator FORSHAW—That was agreed, was it?

Ms Murnane—That is the position, yes.

Senator FORSHAW—There are a lot more people involved in stage 3 particularly thanin stage 1 and, presumably, the cost would be quite substantially more—it is about 40:1000.

Ms Murnane—There is no intention that the Commonwealth would be involved in thepurchase of heroin for the trial.

Senator FORSHAW—What I think is important here, apart from the issue of whether ornot the trial goes ahead—that is a matter for people to have different opinions on, and nodoubt it is going to be debated today at cabinet; it has certainly been debated in the press inrecent days—is that early on it appeared that the trial had, at best, a fifty-fifty chance ofgetting up, because a number of the states, particularly a couple of the major states, includingNew South Wales, were opposing it. That position has now changed, at least for stage 1.

The majority of states and territories, including two of the biggest states—and that is notto attack the smaller states—given the magnitude of the problem, particularly in states likeNew South Wales, are now supporting at least stage 1. It appears that as the issue has goneon and been debated, and certainly in the ministerial council, the states have been preparedto support a trial. The minister has also, on that basis, I would suggest, indicated support forthe trial. At any time prior to and including the meeting of the ministerial council, was theminister aware of the opposition of the Prime Minister to this trial?

Senator Herron—That is a hypothetical question. It is not the officer’s position to respondto it, Senator Forshaw. She would not know. How can you ask a question like that? I amsurprised.

CHAIR —Nor does it pertain to estimates, Senator Forshaw, so I will have to rule thequestion out of order. I am sorry.

Senator FORSHAW—I ask you to consider that ruling. Why does it not pertain toestimates? What we are talking about here, firstly, is an issue that was clearly the subject ofdiscussion and question at the last hearing. The officers provided information at that time andalso indicated that really it was a matter that was going to be further discussed at theministerial council. So clearly it was an issue that could not be fully canvassed and resolvedin the last hearing. Secondly, if it goes ahead, it does involve the expenditure of Common-wealth funds—that has been acknowledged. Thirdly, this is an issue of major public importanceinvolving, among a whole range of issues, the administration of the national drug strategy,which is a matter clearly within the estimates and covered in the portfolio statements.

The issue of whether or not the Prime Minister supports or opposes this program, andwhether or not that opposition was known to the minister and conveyed to the other membersof the ministerial council, I would have thought was a very relevant issue and that the questionshould be allowed and should be answered.

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CHAIR —Senator Forshaw, your preamble to the issue itself is quite appropriate and quitecorrect in its relationship to estimates, but the actual question that you ask—asking for theknowledge in the minister’s mind as to what the Prime Minister was thinking—I will still ruleout of order. Not only is it not appropriate to estimates but also it is hypothetical, and it isasking for an opinion that is simply hypothetical. I rule it out of order.

Senator FORSHAW—I put it on the record, Chair, that I disagree with your ruling. ButI will ask this question: did the minister ever advise the states and territories, and particularlydid he advise them at the ministerial council, that this was a decision that ultimately wouldhave to be made by cabinet?

Senator Herron—I can answer that, but it has already been answered by the officer whenshe read out that the Commonwealth advised that the trial will only proceed on the basis thatAustralia meets international treaty obligations and that it is formally put through theinternational narcotics controls.

Senator FORSHAW—With respect, Minister, that is not what I asked. I asked whether ornot it was conveyed to the ministers from the states and territories that the final decision onwhether or not the trial would go ahead would be a matter for cabinet. I do not think yourreference to the caveat, as it were, relating to the international obligations is indeed evenrelevant to the question I am asking. I would also put to you that they are issues that havenot even been resolved yet. The cabinet is meeting today to make a final decision on this issue.

Senator Herron—Yes, I do not disagree with that. I am saying that it is not for the officerto respond to that sort of question.

Senator FORSHAW—No, that is not what you said a moment ago, Minister. You actuallygave me a different answer.

Senator Herron—You have subsequently stated what I was going to say: that it is up tocabinet to determine.

Senator FORSHAW—The officers, when asked whether or not a heroin trial was likelyto proceed, told the committee at the last hearing that the position of the minister in chargeof this portfolio was one which was very much dependent on the attitude of the states. It wassaid that we knew the ACT wanted to have a trial. It is put that the Commonwealth wouldnot support such a trial unless you had a majority of the states and territories in support ofit. That is the position that is put. There was no mention of whether or not the cabinet wouldultimately have to decide this. It is put that this is effectively a matter which depends verymuch on the attitude of all the states, because they have to deal first hand with the issue ofheroin addiction.

The ministerial council meets and decides to support stage 1 of the trial. I would like toknow whether or not, when they made that decision, they were aware that their decision wasgoing to be subject to a further decision of cabinet where the minister would be overruled?

Ms Furler —The MCDS accepted the high-level recommendations and the general directionsspelt out in the working party report. There were a lot of matters of detail that needed to besorted out. I have alluded to several within the Commonwealth’s backyard to do withinternational obligations, and there were several other issues that needed to be considered aswell. We moved immediately to establish a Commonwealth IDC which commenced work on7 August to work out exactly what needed to occur in order for the heroin trial to proceed ifthose international treaty obligations were met.

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Similarly, in the ACT, they were still in the business of sorting out exactly what they wouldneed to do in order to commence a heroin trial should it get the go-ahead next year. Questionsof whether issues needed to be referred to cabinet may well have come up in the process ofidentifying those issues and sorting out what needed to be done.

Senator FORSHAW—Do you know whether or not they did come up? What you have justsaid only reinforces the point that I am making, that a decision was made in principle andstructures and groups were established to look at the details of implementing that decision inprinciple. Presumably, not all that work has been done by today and it would continue for theremainder of this year. Yet now we have a position where, at the end of today, if the cabinetdecides that the Commonwealth will not support, participate in and help to fund the trial, allof that becomes a nullity.

Ms Furler —Some work was done over the last week in order to clarify some legal issuesfor cabinet’s consideration—not every issue, but some of the legal issues that were involved.

Senator FORSHAW—What were the legal issues?

Ms Furler —Whether or not there would need to be new legislation within the Common-wealth to enable such a trial to proceed.

Senator FORSHAW—That work was done over the past week, was it?

Ms Furler —Yes.

Senator FORSHAW—Does that mean that, prior to this past week, that issue was not onethat was known or had been considered by the Commonwealth or by the states?

Ms Furler —Attachment G of the working party report refers to the sort of legal issues thatwould need to be clarified if the trial were to go ahead. The comments that are contained inattachment G are fairly high level. They are not comprehensive and we were always awarethat they would require more attention.

Senator FORSHAW—Attachment G is what?

Ms Furler —Attachment G of the working party report—the working party that wasestablished by MCDS to develop the heroin trial proposal over the last year.

Senator FORSHAW—And the report, including attachment G, was available at theministerial council meeting, was it?

Ms Furler —Yes, that is right.

Senator FORSHAW—You have confirmed what I understand, that is, these legal issues—not the international obligations but these legal issues—which apparently have only surfacedin the public domain within the last week when the Prime Minister, amongst others, referredto them, in fact were known and were on the table for all participants to see at the ministerialcouncil meeting.

Ms Furler —They were on the table to be clarified. They could not be clarified at MCDS.They were issues that had been identified as needing further clarification, should the herointrial proceed to the next stage.

Senator FORSHAW—So they were issues that do not relate to stage 1; they were issuesthat relate to stage 2.

Ms Furler —They certainly related to all three stages, but they needed to be clarified inorder for stage 1 to commence.

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Senator FORSHAW—That is right; and one of those issues is whether or not theCommonwealth government would be required to amend legislation to allow the legalimportation of a prohibited narcotic. That is at least one of the legal issues that—

Ms Furler —That is one of the issues and it is bound up with the international treatyobligations as well. It cannot be separately dealt with.

Senator FORSHAW—But it is a pretty important issue, isn’t it?Ms Furler —Yes.Senator FORSHAW—And it is a matter that the Commonwealth alone could make a

decision about.Ms Furler —Obviously, they are questions for the Commonwealth, but they were contained

in attachment G as issues that would need to be sorted out if the heroin trial were to proceedto the next stage. The working party report did not contain definitive advice on this issue.

Senator FORSHAW—It is a pretty simple issue, this single part of it: ultimately, wouldthe Commonwealth government be prepared to enact the required amendments toCommonwealth legislation to enable the legal supply of heroin for the trial to take place.Despite all of the complexities that surround this trial, that is basically a ‘yes’ or ‘no’ positionfor the Commonwealth. Either they would agree to the trial going ahead and, in turn, agreeto amend the legislation—

Ms Furler —The agreement was for the trial to go ahead, subject to certain conditions beingmet. One of the issues that needed to be sorted out was the legal issue, and that was very muchbound up with the international treaty obligations.

Senator FORSHAW—That is all very interesting, Ms Furler, because what is worrying andtroubling a lot of people is that, in the past week, the Prime Minister has publicly said—andI saw the interview—that the Commonwealth had the power to decide whether this trial couldgo ahead, because it ultimately had the power to determine whether it would agree to theamending legislation on this particular issue of the importation of heroin.

That is a pretty fundamental issue which, one would assume, should have been uppermostin the minds of the participants at the ministerial council meeting and certainly should havebeen, I would suggest, communicated quite forcefully to the other states by the minister.Apparently what has happened is that all the state ministers and the federal minister have sataround the table and have agreed, in principle, to the trial. Yet, the position of theCommonwealth on whether it would take the final step that would enable it to go ahead, waseither not known to them or not communicated to them or considered by them to not be animpediment to the trial going ahead. Can you indicate to me what the position was at themeeting?

Senator Herron—Senator Forshaw, the officer has already answered that because she saidthat it was subject to certain caveats, in your own words. That is what they understood.

Senator FORSHAW—What I would like to know, Minister, is: how was it that theministerial council was able to come to a decision to support the trial—

Ms Murnane—Senator, it is not unusual—Senator FORSHAW—I would suggest that it is unusual in these circumstances.CHAIR —Could you let Ms Murnane finish the sentence.Senator FORSHAW—Chair, I had not actually finished asking the question and making

the point. The position we have is that, until about a week ago, there had been no mention

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publicly, that I can recall, by the Prime Minister or the minister on the issue of whether theCommonwealth was prepared to agree to the trial and amend the relevant legislation. Whatwe have had in the past week is a statement by the Prime Minister which clearly indicatedthat they would not be prepared to do that. Given that this was a very important issue and thatthe attitude of the Commonwealth on that question was very relevant to the decision madeby the ministerial council, was it considered, and was it put by the Commonwealth to theministers at that meeting, what the Commonwealth’s attitude would be on that question?

Ms Murnane—What I was going to say was that it is not unusual for ministerial councilsor, indeed, other deliberative bodies, to come to an in-principle decision, subject to mattersof significant detail being sorted out later and, fundamentally, that is what we are dealing withhere.

Senator FORSHAW—Frankly, I would have to suggest, that it reminds me a little bit ofthe Super League and ARL debate, where everybody was apparently heading down one trackand then, it has been alleged, all of a sudden one party went off in an entirely differentdirection.

It was said that the essential ingredient to getting support for a trial was that the majorityof states and territories supported the trial. That is what they did at the ministerial council.Presumably, they did it with an understanding that the Commonwealth would not unilaterallyput a major impediment in their way at the 11th hour by making a decision, not based uponwhat the views internationally are, but based upon the views of the cabinet and that is,‘Notwithstanding what you agreed at the ministerial council, we, the Commonwealth, are notprepared to amend the legislation.’ That is the position we are at at the moment.

That is why I would like to know whether the minister was acting with the approval ofcabinet when he went to that meeting and indicated that if the states and territories by amajority supported a trial the Commonwealth would be prepared to cooperate, subject to theseother details.

Senator Herron—That question cannot be answered, Senator Forshaw, because, as youknow, discussions in cabinet are not public and nor should they be. What might have occurredin a past cabinet meeting or is likely to occur in a cabinet meeting today is anybody’s guess.So it is an unfair question of the officer in the first place, and in the second place she hasmade it perfectly clear all along that the minister said it was subject to certain caveats, whichI will not repeat. He, in principle, as I understand it, supported the decision. But, subject toall those other caveats, she cannot answer possible communications between the minister andthe Prime Minister, nor can she answer about any discussions that may or may not haveoccurred at cabinet. I do not think your question can be answered.

Senator FORSHAW—I did not ask about what was discussed at cabinet, Minister. I askedwhether the minister was acting with the approval of cabinet.

Senator Herron—You can only get the approval of cabinet by asking cabinet.

CHAIR —It is six of one and half a dozen of the other, Senator Forshaw. You have nowasked the same question five times. You have been given the same answer five times that thatis where the government is at today in relation to making decisions, based on the caveats thatwere put to the ministerial council meeting. Could I ask you to move on, because we are justgrinding to a halt here, in that you keep asking the question and the officers and the ministerkeep answering it. So could I ask you to move on.

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Senator FORSHAW—I keep asking the questions, Chair, because I would suggest that,at least in respect of the minister, there is an attempt to avoid answering the question. I willgo back to the question I asked—and this is a very important issue, Minister.

CHAIR —This will be the last time you can ask the same question. I will rule it out of orderin future.

Senator FORSHAW—I do not think I have asked the same question.CHAIR —You have. The same answer has been given to you repeatedly, Senator Forshaw.

The officers simply cannot answer it seven or 10 different ways, no matter how many timesyou want to ask the same question. Move on, please, Senator Forshaw.

Senator FORSHAW—Chair, this is a matter that the cabinet today is obviously going tobe spending some time debating.

CHAIR —That is correct.Senator FORSHAW—I would have thought that people might be prepared to give it a little

bit of attention at this committee. It is a very important issue.CHAIR —I am not disputing that the issue is an important one, but what cabinet is debating

today is of no business of yours or mine, because we are not privy to those discussions, andyou cannot ask the minister at the table, nor the officers, what is going to transpire today, whatadvice has been given to the minister or anything else in relation to it. So I ask you, SenatorForshaw, to move on.

Senator FORSHAW—Minister, I have not asked a question about what is going to happentoday. I have just pointed to the fact that it is public knowledge that they are meeting today.The question I have asked, and I will ask it again because it has not been answered, and itis a question that is completely in order, is whether or not the minister, when he attended theministerial council and put the position of the Commonwealth, did so with the authority ofcabinet. That is a question which relates to whether or not the cabinet had actually decidedto give the minister approval along those lines. That is not a secret. That is not asking whatwas discussed at cabinet. It is asking what, if anything, cabinet had decided about theCommonwealth’s position prior to the ministerial council and what direction was given to theminister to put on behalf of the Commonwealth. Could you answer that?

Senator Herron—No, it is impossible to answer that question. As I say, none of us can tellyou what might or might not have occurred at a previous cabinet meeting. Nor do we knowwhat is going to occur today. Your question in summary was: did the minister have theauthority of cabinet to—

Senator FORSHAW—Yes.Senator Herron—We cannot answer that, because we do not know. Do you accept that we

do not know?Senator FORSHAW—If your answer is that you do not know, I would like to know why.

Either the cabinet discussed it and made a decision or they did not.Senator Herron—Whether we as a government did know or did not know, we are not going

to convey to you what discussion occurs in cabinet.Senator FORSHAW—I did not ask for the details of the discussion. I am asking for details

of the decision. Minister, decisions of cabinet are actually matters that are communicated. Thedecision of cabinet today, presumably, will be released to the public or are you telling me thatwhat occurs at cabinet today will be kept a secret, that nobody is allowed to find out?

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Senator Herron—You answered your own question.Senator FORSHAW—That is what you are suggesting.Senator Herron—You answered your own question because you said, Senator Forshaw,

that decisions of cabinet are made known to the public. There is no public knowledge of anydecision of a previous cabinet meeting in relation to the trial. You should just settle down.You have answered your own question. We should move on.

Senator FORSHAW—I am entitled to ask questions at this committee meeting.CHAIR —Senator Forshaw, it would be appreciated if you did not interrupt the minister or

the officers when they are answering your questions. They do not interrupt you. I askrespectfully that you do not interrupt them. Senator Herron, had you finished?

Senator Herron—Thank you.Senator FORSHAW—Minister, I am entitled at this committee to ask whether or not

cabinet has made a decision to give approval to a minister to put a particular position on behalfof the Commonwealth to a ministerial council meeting. Either the cabinet did or the cabinetdid not. If you do not know, I would ask that the question be taken on notice becauseultimately it is a matter of record whether the cabinet, prior to the ministerial council, madeany determination about this position.

Senator Herron—I will repeat it again, Senator Forshaw.Senator FORSHAW—Would you take it on notice, because we are not going to get

anywhere?Senator Herron—You do not seem to listen. Any discussions in cabinet are the privilege

of cabinet. I suggest that you are not going to get an answer as to what discussion occurredin cabinet about any previous trial. You will get a decision today, if cabinet makes a decisiontoday. It may not make a decision today. All your questions in the second part arehypothetical.

Senator FORSHAW—Minister, with respect, I have not asked you at all to tell me whatdiscussions occurred. All I have asked is whether or not cabinet made a decision. That is aperfectly reasonable question. We ask that question every day of the week in committees andin the parliament. Has the cabinet decided this way or that way? I have asked whether or notthe cabinet decided and gave approval to Minister Wooldridge to put the position to theministerial council that was put. If you do not know, please take it on notice. I am not askingfor details of the discussions.

Senator Herron—It did not make a decision, did it?Senator FORSHAW—I am asking you.Senator Herron—You said it would be public knowledge if it did make a decision.Senator FORSHAW—I did not say that.Senator Herron—Whether you did or you did not—Senator FORSHAW—I said decisions of cabinet are ultimately public knowledge.Senator Herron—Whether you did or you did not, it will be on theHansardrecord.Senator FORSHAW—Of course it will.

Senator Herron—There was no decision taken. That is fairly obvious. Otherwise we wouldall be aware of it. A decision presumably will be made today. If you wish to ask a question

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of the minister, I am happy for you to do so and we will put it on notice for you. But I suggestto you that, by the time you get an answer to it, it will be immaterial.

Senator FORSHAW—I do not think it is immaterial, Minister.

Senator Herron—We will put it on notice.

Senator FORSHAW—Ultimately, what is at issue here, separate from the issue of whetherthe trial goes ahead or not, is—

Senator Herron—We will put it on notice for you.

CHAIR —Your question is on notice, Senator Forshaw.

Senator FORSHAW—What is at issue is the process of decision making within the ministryof health with respect to this issue, whether or not it was indicated that this was ultimatelya matter to be decided by cabinet. That is a matter that the states would have a great interestin.

CHAIR —Your question is on notice, Senator Forshaw.

Senator FORSHAW—You indicated a moment ago, Minister, that Minister Wooldridgeagreed to support the trial. That was his position.

CHAIR —In principle.

Senator FORSHAW—Minister, you indicated a moment ago that Minister Wooldridgeagreed to support the trial.

Senator Herron—Subject to caveats.

Senator FORSHAW—Could you explain why it has been reported in statements over thelast couple of days that, in fact, he had not supported the trial and, rather, that he was scepticalabout it?

Senator Herron—Were you referring to newspaper reports?

Senator FORSHAW—Yes. Could you confirm whether they are true?

Senator Herron—We cannot, one way or the other. We do not know, but we will take iton notice.

Senator FORSHAW—But, as far as you are concerned, the minister supported the trial.You may or may not wish to answer this: would you like to tell us what your view on the trialis? I ask this genuinely, given your involvement in the profession.

Senator Herron—Yes, I am happy to. I have got a genuine interest in this. In 1992, I wentto Amsterdam and inspected the controlled heroin trial there. Three weeks ago, I went to theWorld Health Organisation in Geneva and spent time with officers there in relation to theirreview of the Swiss trial. This is a very major issue; there is no question about it. It is aproblem for the whole world.

My information from the World Health Organisation is that, by the end of this year—I notethat it may be early next year—they hope to have a commentary on that Swiss trial. Mypersonal view is that many trials have been done throughout the world and it remains to beseen whether any of those trials have produced any long-term results that are beneficial to thecommunity.

Senator NEAL—Are you saying that none of those international trials have actually beenassessed to date?

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Senator Herron—No, I am not saying that at all. The World Health Organisation will beassessing the Swiss trial, which is the latest of many trials that have been done throughoutthe world in relation to the distribution of heroin. I have a copy of that, if anybody wishesto look at the full details of the Swiss trial, and you can form your own opinion on it.

Senator NEAL—We would be interested in that. Also, if there has been assessment of othertrials internationally, I would assume that the department has had a look at those. Is that thecase?

Senator Herron—I cannot answer that.Ms Furler —I cannot answer that definitively either, except to say that I am sure that the

working party appointed by the MCDS canvassed the literature that was available.Senator NEAL—But the department itself has not looked at trials that have occurred

internationally. Is that what you are saying?Ms Murnane—We will look at what assessments and evaluations have taken place and

provide you with a list of them and, if we can get copies of them, we will provide you withthose.

Senator NEAL—Yes, I am interested in getting information about what has occurredoverseas. I find it unlikely that the department has not bothered to look at it at all.

Senator Herron—No, the Parliamentary Library Research Service has done excellent workon this and it is freely available.

Senator NEAL—The library is obviously not the same thing as the department.Ms Murnane—I think it was further said that the working party has taken cognisance of

those reports. What we do not have is information on them before us at the moment, but wewill find it and provide it to you.

Ms Furler —We had departmental officers on the working party who were staff membersof the Public Health Division, but it was not the job of the Public Health Division of thedepartment to craft these proposals. The ministerial council appointed an expert committeeand they certainly had to look at the literature that was available.

Senator NEAL—But I would have assumed that, in providing the minister with advice aboutwhich approach he should be taking, the department would have reviewed the state ofinformation at the moment.

Ms Furler —Yes.Senator DENMAN—Senator Herron has been to the Netherlands and Geneva and looked

at the trials. Have any departmental officers been overseas to look at some of these trials?Ms Furler —I cannot answer that. I would have to take that on notice.Senator Herron—Interestingly enough, at the World Health Organisation, I am very pleased

to tell you that there are a large number of Australian medical officers who are keenlyinterested in this. It is a matter of a phone call—without going there—and the material isavailable to us. It is probably not the role of the World Health Organisation just to evaluatetrials. I am sure that the ACT, as the lead government in this regard, has all that materialavailable as well. Obviously, it is a matter that has keenly interested medical authorities formany years.

With all the trials that have been done, the difficulty is assessing, on the one hand, whetherthe cost of the trial to the community is counterbalanced by the savings in relation to crime

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related events that occur in trying to get money for drugs. The other aspect is: what percentageof heroin users eventually become free of addiction?

Senator DENMAN—Surely one of the other questions ought to be how we best help theaddict?

Senator Herron—Yes. I am glossing over all the things but they are the two things thatare very difficult to evaluate. You have to evaluate them over very long periods of time. TheSwiss trial is the first five-year evaluation. I do not think we will get a definitive answer fromthat, either. Similarly, as the ACT has correctly pointed out, there have to be three phases ofthis. It is a very long-term commitment. You have heard about the funding of it. With regardto whether that helps the heroin addicts themselves, you can only talk in percentage terms.In the first five years of the Swiss trial—I will have to get the report to see the exact figures—a very small percentage of the individuals actually became non-addicted.

CHAIR —Are there any further questions on 1.1?Senator WEST—Can I change drugs? Senator Herron, you and I have an interest in a

tobacco report that was tabled before the end of 1995. Can somebody give me some indicationof when we can expect a response?

Senator Herron—Yes.Senator WEST—Radio National did a very good program on it, I thought.Senator Herron—I thought it was an excellent report; quite an outstanding one. In fact,

I was complimented on it, you will be pleased to know—as you were—at the World HealthOrganisation. They were well aware of the report and complimented us on it. They have askedfor further copies of it.

Senator WEST—I would like to know what the government is going to do with the report.Senator Herron—I thought I would let you know that because I was pleasantly surprised.

I did not mention it but we were in the drugs of addiction section at the World HealthOrganisation. We are hoping to get a government response fairly soon.

Senator WEST—Yes, but we have been told that for the last 18 months.Senator Herron—Yes, because along with every other report that is all embracing, such

as that was, there needs to be consultation with the various states, non-government stakeholdersand other Commonwealth portfolios. For example, it goes across, as you know, Treasury;Industry, Science and Tourism; Employment, Education, Training and Youth Affairs; andPrime Minister and Cabinet.

Senator WEST—That is fine. You have given me a good list of where it has to go. Canyou tell me—maybe you are going to have to take this on notice—what consultations havetaken place with the states, what consultations have taken place with the territories, the non-government organisations and the other departmental agencies?

Senator Herron—I am interested as well. We might get Mr Fox to bring us up to date.Mr Fox —My section has been looking after the response to the report that you mentioned.

We have had extensive discussions with other portfolio agencies. The minister, on 2 Augustthis year, wrote to the other portfolio ministers seeking their approval to table the response,with a view to actually tabling the response later this week if we get the appropriate approvalsback, or shortly thereafter.

As has been mentioned, we have been consulting on and off with the various departmentssince January 1996 and we have come up with a fairly comprehensive response to the excellent

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report that you have mentioned. We have also discussed the draft response with a number ofthe major health groups who made submissions to the inquiry and through the ministerialtobacco advisory group that the minister created in July 1996, which was responsible fordevelopment of the tobacco campaign.

Senator WEST—Yes, but in the response the minister gave he said there had to beconsultations with the states and territories as well. Have any of those been undertaken?

Mr Fox —There have been informal discussions with the states and territories.

Mr Fox —There have been informal discussions with the states and territories.

Senator WEST—That is a lovely word ‘informal’, because it gets you out of a lot ofscrapes, doesn’t it? I am happy for you to take this on notice, but I would like an indicationof how many informal discussions may have taken place with the states and territories on thisissue.

Mr Fox —I cannot put a figure on it, but I have had regular phone conversations with someof my counterparts in the states and territories.

Senator WEST—So it has not gone minister to minister or anything like that?

Mr Fox —Not that I am aware of.

Senator WEST—No. My advice as well is that none of the ministers has had discussionsabout it. It is informal consultation at officer level.

Mr Fox —That is right.

Senator WEST—And you do not know what the states officers may well have done if theyhad relayed those conversations back up to the minister in a note or anything like that?

Mr Fox —No, I am not aware of that.

Senator WEST—So there has not really been a great deal of work done with the states.

Ms Furler —It was necessary for us to informally talk to our counterparts in the states andterritories because a number of them have enacted legislation restricting smoking in publicplaces—

Senator WEST—I know, and that is why I thought it would have actually gone fromminister to minister.

Ms Furler —It was necessary for us to understand those initiatives in order to make anappropriate response at the Commonwealth level. So just in a process of refining theCommonwealth response, the whole-of-government response to this report, it was necessaryfor us to understand those initiatives—some of them have been quite recent.

Senator WEST—I thought if you were going to understand the initiatives and understandthe responses you would have actually wanted a few pieces of paper to float by. I would havethought, given that the report contained a number of recommendations that were theresponsibility of the states and territories to administer, that in fact you would have beenforwarding copies of the report to the ministers.

Ms Furler —I do not know how the report was distributed. We would have to take that onnotice.

Senator WEST—I would appreciate it if you did that, please, and I would appreciate someindication of the extent of the informal consultation that has taken place with the states andterritories. I certainly plan to see if it has been at a level sufficient for the officers at the state

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level to have gone back up to the ministerial level to seek their comments or input. If that hasnot happened, then it has been a bit of a waste of time, hasn’t it?

Ms Furler —We do that sort of informal checking out in the course of our day-to-day workwith respect to a wide range of things so that we are conducting our business appropriatelyat the Commonwealth end. As I said, it is an essential part of our business, so we will takethat question on notice for you.

Ms Murnane—Senator, if I could just clarify, it is not unusual with the number ofparliamentary reports for us to canvass the views of states, territories and stakeholders beforethe Commonwealth makes a response. We do not have to, and ‘informal’, in fact, is notsomething that is derogatory in this at all. That would be one of the ways in which we canvassit. We are not seeking permission or approval. What we are trying to do when we respondis to be able to take account of the range of relevant views on the report, and that is what MrFox and Ms Furler have been describing here.

Senator WEST—I was not meaning to imply that, Ms Murnane.

Ms Murnane—Sorry, I just wanted to clarify it.

Senator WEST—But there certainly have been comments about that report, certainly, fromthe tobacco manufacturers, that it was a useless report because the Commonwealth has littlepower to implement any of the recommendations. I would have thought, as it was a report ofsuch significant recommendations for the states and territories, that there might have been somemore formal type consultations that would have taken place.

I hope, therefore, that when we get the government’s response to the report that thoserecommendations that are related to the states—and I am seeking assurance here—are goingto be more than the usual two or three lines that say, ‘This is the responsibility of the stateand territory governments, therefore we are not able to make a great deal of comment’ andleave it at that. I would hope, as it has taken so long and there has been such in-depth informaldiscussions from Ms Murnane’s comment, that there will be more than just a two- or three-linethrowaway. Can I have an assurance that that will be the case or will I have to wait and see?

Ms Furler —The response is to be tabled by the minister. We certainly are not able to makeit available until that has occurred.

Ms Furler —The response is to be tabled by the minister. We certainly are not able to makeit available until that has occurred.

Senator WEST—I am not asking for what is in it but I am asking for an assurance that itis going to be more than just—as I have experienced with other reports when a recommenda-tion has been up to the implementation of the states—the throw-away line of one or twoparagraphs saying, ‘Well, this is up to the implementation of the states and territories, theymay choose to do nothing or whatever.’ I am seeking an assurance that because this has takensuch a considerable length of time to prepare, and apparently there has been a lot ofconsultation, we are going to see some in-depth action in the responses.

Ms Furler —The text of that response is with the minister’s colleagues at present.

Senator WEST—I await with interest, because I hope it is not Christmas before we get itagain.

Senator NEAL—Just one question to Mr Fox. Which ministers actually have to tick offthe report before it can be released?

Mr Fox —The ministers responsible for those portfolios that Senator Herron mentioned.

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Senator NEAL—I maybe was not paying proper attention.Mr Fox —That is all right. The letter has been sent to the Treasurer, the Minister for

Industry, Science and Tourism, the Minister for Employment, Education, Training and YouthAffairs, and the Prime Minister.

Ms Murnane—And it is usual—it has been in all governments—for these governmentresponses to parliamentary committees to be approved by cabinet.

Senator NEAL—Is this going to be the case in this situation?Ms Murnane—I cannot say exactly, but I say that that is a usual occurrence, as it has been

over successive governments.Senator NEAL—I just got the impression from what Mr Fox said, that once it was ticked

off it was going to be released.Ms Murnane—I do not think that can be assumed. I think that if this went down the usual

track, it is a government response and it would be considered by the government.Senator NEAL—So it may take some time longer?Ms Murnane—What Senator Herron said is that there will be a response to the report.Senator NEAL—No, I do not think we need to elaborate further on that. I just want to move

on, if you have finished with that, to other areas in 1.1 relating to the national healthagreements. Mr Podger answered these questions last time; I do not know who will be dealingwith them today. Who will that be?

There were two agreements that are in the process of being negotiated, the national healthpartnerships and the bilateral national health funding agreements; which of those have beensigned by which states?

Ms Furler —First of all, they are not both financial agreements. I think I have explainedthis before.

Senator NEAL—No, that is not what I said. If you think that is what I said I will say itagain. Two agreements: one, the national health partnership agreement and two, the bilateralnational health funding agreement.

Ms Furler —If I could just make a couple of introductory comments. The first one is notan agreement. The first one is the national public health partnership memorandum ofunderstanding, and the second is the bilateral financial agreements and I will ask Jan Bennett,who is the Assistant Secretary of the National Public Health Planning Branch to bring youup to date on those things.

Ms Bennett—In the case of the national public health partnership, it has been signed bythe Commonwealth, Victoria, ACT and the Northern Territory. Signing pages are currentlyout with South Australia and Queensland.

Senator NEAL—Currently out did you say?Ms Bennett—Yes. It had been intended that the memorandum would be signed at the

meeting of health ministers but that did not happen so it is actually going around the countryformally being signed one by one at the moment.

Senator NEAL—So even though the others, South Australia—Ms Bennett—South Australia and Queensland have a copy at the moment which they are

formally signing. It will then be sent to the remaining states for signature.Senator NEAL—Is that because the other states have not actually agreed to it?

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Ms Bennett—No, that is just the formal process of sending it around the country to sign.Senator NEAL—But why has it been sent to Queensland and South Australia but not to—Ms Bennett—It was actually sent to all of the states one at a time—there are actually two

signing pages so it is being sent to two states at a time. When they sign it they return it andwe send it to the next two.

Senator NEAL—Have all of them actually agreed to sign it?Ms Bennett—All have agreed to sign except the possible doubt is Western Australia and

their position is changing frequently so we are not entirely sure which way they will jump inthe end.

Senator NEAL—What is the sticking point with Western Australia?Ms Bennett—It is an issue over whether the Commonwealth will be determining priorities

for the state rather than allowing the state the flexibility to determine its own internal priorities.We have made a number of steps to assure them that the memorandum is about clarifyingwhere the Commonwealth’s role is, as distinct from the state, but not overriding the state’sresponsibilities at all.

Senator NEAL—The memorandum of understanding that I have got was the proforma thatwas used as a base to start negotiations. Is the agreement that is being presently circulated thesame as that that I have been provided with?

Ms Bennett—I would think so. The detail of the memorandum has not changed since April.Senator NEAL—It depends on what version I got.Ms Bennett—I can make sure you get the final version, but there has been no change to

the wording of the memorandum for some months. Since then, it has been a matter of findinga way to formally get everyone signed up.

Senator NEAL—It interests me that Western Australia is concerned about setting objectives,because from my quick perusal of the memorandum there is really very little of major detail—it is very broad brush. Is it envisaged that, arising from this agreement, there will be furtherdetailed agreements that rely on this memorandum?

Ms Bennett—No, there is a work program that underpins this memorandum through thenational public health partnership. All states and territories, including Western Australia, havebeen active in meetings of that partnership group and they will, over the course of time,develop a whole work program around the sorts of issues in here. But they are not agreementsas such. They are just a work program to underpin the memorandum.

Senator NEAL—I do not really understand what you mean by ‘work programs’. What doyou actually mean?

Ms Furler —Could I perhaps clarify something and then go on to explain that? Thesignificance of the memorandum of understanding for the national public health partnershipis that for the first time it clarifies the respective roles and responsibilities of the Common-wealth and the states in the area of public health. As such, it is not a particularly startlingdocument.

Senator NEAL—I have got a copy of the document.Ms Furler —Yes, but if I can just comment: what it does is provide the framework then for

a rolling work program that is targeted at strengthening national public health infrastructureand response capacity over the next three to five years. So we are talking about theCommonwealth and the states shifting from a situation where they were participating, where

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they were collaborating, in areas of particular disease or risk factor concern, like drugs andHIV-AIDS, for example. We are going to continue to do that, but we are also going to extendour collaboration now to do things about the public health infrastructure in Australia. So weare going to strengthen national public health information, the legislative framework withinwhich we all conduct our business, work force development, research and development—thosesorts of infrastructural support issues. That is, in fact, the significance of the memorandumof understanding. It extends the Commonwealth/state collaboration further.

Senator NEAL—I have read the contents and the principles contained in that agreement.What I would like to know is what these work programs actually mean?

Ms Furler —I think the simplest thing for us to do would be to send you a copy of thecurrent work program.

Senator NEAL—Okay, that would be very helpful. I notice that in the memorandum oneof the objectives was to facilitate the contribution of all providers of public health services,such as local government, public health—and it goes on. Was local government, or arepresentative of local government, involved in the discussions or negotiations at all?

Ms Furler —Local government was involved very early on in discussions with stakeholdersabout this concept of the national public health partnership. They are not formal signatoriesto the national health partnership.

Senator NEAL—I can see that.Ms Furler —They certainly are not at the table of the national public health partnership

group, which oversights the work program. But they are involved in an advisory structure thathas been established for the partnership and we are certainly looking forward to theinvolvement of local government in aspects of the work program.

Senator NEAL—Who is on this advisory structure?Ms Furler —There are a number of peak bodies that have been invited to join the advisory

structure, ranging, I think, from the Consumers Health Forum, local government, to the PublicHealth Association of Australia—

Ms Bennett—The RACGP.Ms Furler —Several royal colleges.Senator NEAL—I am sorry, I did not catch that.Ms Bennett—The Royal Australian College of General Practitioners.Ms Furler —Again, we can send you a list of the bodies that are involved.Senator NEAL—That would be useful. Who was the person who actually represented local

government in the early stages of the negotiation?Ms Furler —I am afraid we would have to take that on notice. There were at least two

people from the peak organisation who were involved in discussions that we have had.Senator NEAL—If you could, that would be helpful as well. When was the health ministers

meeting?Ms Furler —That was on 1 August.Senator NEAL—Can you give me a run-down on who has agreed or signed the funding

agreements?Ms Bennett—One of the territories has signed the funding agreement.

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Senator NEAL—Which one?Ms Bennett—The territory has not in fact announced that in the territory yet. I spoke to

their chief medical officer yesterday, and while they are quite willing and happy for theagreement to be made public and shared, they would like the opportunity for the territory toannounce that it has signed before we announce it publicly.

Senator NEAL—I do not know if the wish of the Northern Territory government to makea publicity splash in the Northern Territory is really a basis for withholding information atestimates.

Ms Furler —Senator, I would ask for your consideration and indulgence on this point,because we have worked quite hard with people in the different states and territories to cometo a point of agreement. As Ms Bennett has said, in conversations yesterday with officers ata high level involved in that jurisdiction they asked that we wait to provide details on theagreement until they have had the opportunity to make it public.

Senator NEAL—But this is estimates; this is not a public statement. This is theaccountability of the executive government to the parliament, and I am asking a question. Ifyou wish to pass me a note or something like that, I am happy to do that, but I do not reallythink it is a basis for withholding information from me.

CHAIR —Senator, the officers have simply asked for your indulgence not to have thatdiscussed here.

Senator NEAL—I understand that. I do understand English.CHAIR —That is good. I am glad you understand English, because then you understand what

has been asked of you.Senator NEAL—I have responded that I do not see that as a basis for withholding

information from me. If they wish to pass me a note so that it is not on the public record, sothat that territory can have its moment of glory, fine.

Senator Herron—Senator Neal, we are happy to give you every bit of information possible.Nothing will be under the table or on bits of paper, it will be on the public record. That whichis available on the public record will be on the public record. If the officer can answer thequestion, I am sure that she will.

Senator WEST—There is nothing that is marked AUSTEO—‘Australian eyes only’.CHAIR —Are there any further questions?Senator NEAL—Yes. If you want to pass me a note so that it is not on the public record,

fine, but I would like to know.CHAIR —The officers have clearly given an indication to the jurisdiction that they will not

be releasing the information. They have requested that they not release the information at thisstage. I am sure that you will be able to get the information as soon as it is released, Senator.

Senator NEAL—That is not a basis for refusing, I am sorry.Ms Furler —I think it really is only going to be a matter of a few days before there is an

announcement in that particular territory. As I have said, a lot of our work in public healthinvolves us having good relationships with people in the states, and we really are asking youif you would not mind holding off for a few days until they have made their announcement,because then we can make that material available to you.

Senator NEAL—My response to that was that I am happy if you want to provide it to menow on a confidential basis.

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Ms Furler —If the minister is happy for us to do that, we will do so.

CHAIR —Minister, would you be in agreement to providing that information to SenatorNeal?

Senator NEAL—I will undertake not to release it before they have their moment of glory.

Senator Herron—This is a matter between the states and territories and the Commonwealthgovernment, and we are not prepared to provide it to you.

Senator NEAL—I hope you get more than two lines in the back of theNorthernTerritorian. Bearing that in mind, can I have an undertaking from the minister that I will bedirectly provided with that information as soon as the territory gets its moment of glory?

Senator Herron—It is not a question of the territory getting its moment of glory. We arehappy to give the information to you after the election, which is in a week’s time, providingit has been announced by the Northern Territory government.

Senator NEAL—It is not a matter of publicity; it is a matter of this government protectingthe interests of their coalition government.

Senator Herron—Not at all. It is the prerogative of the Northern Territory government tomake the announcement.

Senator NEAL—I have the information I want, thank you. Can we go on to which otherstates and territories have signed agreements?

Ms Bennett—Yes. In addition, there are four states and territories where the detailed fundinghas been agreed. In the case of one of those, the agreement is with their health minister forsigning. It has been through their cabinet and all of those processes. In the case of the otherthree, it is either—

Senator NEAL—Which ones are they, please?

Ms Bennett—South Australia—

Senator NEAL—Are these the ones that have agreed?

Ms Bennett—They have agreed on the detail but have not yet signed—South Australia,ACT, Victoria and Tasmania. In the case of Victoria and Tasmania, there is some finetuningof indicators, but the detailed funding has been agreed. We expect those four to be signedwithin a matter of weeks, depending on how long they go before cabinet.

Senator NEAL—And the other three—New South Wales, Queensland and WesternAustralia?

Ms Bennett—We expect Queensland to agree by the end of the month or not long after.There was a detailed meeting last Monday to thrash out the remaining issues. Queenslandconfirmed their position in writing yesterday. We think that we have got over those hurdles,so we think an agreement will not be far off for them. I am meeting with New South Walesthis Thursday to progress the detailed discussions.

Senator NEAL—How far have you got? Do you think it is likely that they are close toagreement?

Ms Bennett—In the case of New South Wales, a funding offer has been put on the table,so we will be discussing that detail. In the case of Western Australia, a funding offer has notbeen made because, at this stage, they have not agreed to participate in the discussions.

Senator NEAL—At all?

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Ms Bennett—We had one very early round of discussions some months back, but since thenthey have not progressed discussions with us. There have been a number of letters backwardsand forwards, but we have not come to the point of making a formal offer.

Senator NEAL—What are the consequences of an agreement not being signed? Does itmean that you go back to the previous situation where you had the SPP, or do they get nofunds at all for those programs?

Ms Bennett—In the case of all of the states where we are making good progress, we havewritten to them and offered to have a transitional arrangement that is based on notionallyhaving agreed to the new arrangements. Rather than go back to extending old agreements ormaking other interim arrangements in the case of the four states plus the one that has signed,we have agreed to transitional arrangements based on an assumption that we will reach anagreement. So they have all been formally agreed to.

Senator NEAL—What I am trying to get at is if, say, the Western Australian negotiationsbreak down entirely and nothing is ever agreed, what is the consequence? Do they not get anyfunds?

Ms Bennett—It will not be the Commonwealth’s intention to deprive the people of WesternAustralia of public health funding. We will not, though, be in a position of extending pastagreements because, in the case of five out of the eight SPPs, the agreement actuallyterminated at the end of June, so those agreements are in fact no longer in place. We will beseeking a range of possible alternatives. At this stage we have not conceded that we will notbe able to reach an agreement.

Senator NEAL—I understand that. I am not assuming that it will not be finalised. I am justtrying to work out what would happen if it wasn’t. Bearing in mind that five out of the eightSPPs have actually expired, what sort of alternative arrangements could you make if they arenot willing to put them all in together?

Ms Furler —With alternative arrangements there are a number of issues that we are lookinginto, including either alternative providers or direct provision by the Commonwealth in somecases.

Senator NEAL—The question is—and not making any assumptions that it will occur infact—if the arrangements, for example, with Western Australia do not progress any furtherand no funding agreement is signed, what is the consequence of that? We have been told thatfive out of the eight SPPs have actually expired, so what alternative arrangements will bemade?

Ms Furler —If Ms Bennett could confirm this, we wrote to the states where proceedingshad not made any progress recently asking for a response and a firm indication from them bya particular date, which I do not have with me. I do not think we have heard back fromWestern Australia. I believe our officers are following up now with Western Australia and assoon as we have some sort of response from them we will be discussing it with the minister.

Senator NEAL—What is the cut-off date?Ms Bennett—I would have to check that.Senator NEAL—Can you take that on notice? Probably it would be good to get a response

soon because if you tell me after the date has passed it is useless. You do not really know whatalternative arrangements have been made?

Ms Furler —I imagine there are several options that our minister would be interested inperhaps exploring, but I cannot pre-empt the discussion.

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Senator NEAL—What is that?Ms Furler —There must be several options that would be worth exploring, but I cannot pre-

empt the discussion that we would have with the minister, nor what he might have with hisWestern Australian counterpart.

Senator NEAL—What sort of option does the department see as worth exploring?Ms Murnane—Ms Furler has said we are negotiating with Western Australia to secure an

agreement. That is still our intention.Senator NEAL—I understand that.Ms Murnane—Clearly, in any sort of negotiation, you always have plans B and C in your

mind.Senator NEAL—That is right.Ms Murnane—But that is not something that at this stage we are able to put on the table.

We are still pursuing the prospect of an agreement with Western Australia.Senator NEAL—I accept that, and I stated that earlier, but you probably did not hear it

because I was on the other side. Bearing in mind that the stated intention of the departmentis still to sign an agreement with Western Australia, but putting that aside for a moment, ifthat does not eventuate, what are the possible alternatives for funding of the health programsfor HIV, hepatitis C immunisation, women’s cancer screening, national women’s healthprogram—all those—if the negotiations do not conclude?

Ms Murnane—That is part of the negotiation process, but let me say that, in the event thatnegotiations with Western Australia are not successful, the funding of those programs will notbe in jeopardy. Exactly how that occurs is a subject for negotiation between us and WesternAustralia when the time comes.

Senator NEAL—You do not have any ideas at the moment?Ms Murnane—We have no ideas that, outside the negotiation process, we can put on the

table at this stage.Senator NEAL—Do you have a final draft of the funding agreements?Ms Bennett—We do have a draft agreement, but I would suspect it is better to wait until

agreements are signed to provide you with those as the detail and the wording changes forvarious clauses as part of the negotiations so that the overall agreement does not end up beingthe exact agreement with any particular state or territory.

Ms Furler —I thought we provided you with those.Senator NEAL—No, you didn’t.Ms Furler —We can provide you with the draft proforma agreement that we agreed to

provide to you at the 2 June hearing. I do not know why it did not come over, if that is thecase.

Senator NEAL—There was some delay disclosed in that response, but it was neverprovided. I want to make it very clear that I have been provided with a copy of the partnershipmemorandum, but I have not been provided with a copy of the funding agreement.

Ms Furler —My recollection is that you asked and we agreed at the last hearing to provideyou with a copy of the proforma funding agreement.

Senator NEAL—That is right.

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Ms Furler —If you have not got that, I will go back and double check and we will makeit available to you.

Senator NEAL—Thank you for that. When we spoke last time it was indicated that it wasgoing to be a two-year agreement and that, although there was provision for a certain sumwithin the budget, that was a negotiable amount, dependent on discussions with the states. Ithink what was budgeted was $132 million. Has a final figure been come up with?

Ms Furler —No. I am sorry; I am not clear of the nature of your question. Could you repeatit?

Senator NEAL—The funding agreements between the Commonwealth and the state thattake over the ASPPs has a provision made in the budget for a certain amount. But Mr Podgeradvised the committee that in fact it could vary, dependent on negotiation between theCommonwealth and the state. What I wish to know is whether a figure has yet been finalised.

Ms Furler —The total amount of funding which is available in bill No. 2 for inclusion inthese broadbanded agreements is in the order of $132 million.

Senator NEAL—That is the figure I just gave you.Ms Furler —With respect to each state and territory, there are incentives money. There is

a base which is on the table for discussion, and there are also some incentives money and somemoneys available for national demonstration projects where these can be negotiated. So it ispotentially variable and a part of the negotiation process—the exact amount finally which willbe made available in these broadbanded agreements.

Senator NEAL—That was my whole question. What I wanted to know is whether that finalfigure had yet been arrived at.

Ms Furler —For each state and territory?Senator NEAL—No, as a total.Ms Furler —I thought I just confirmed the total.Senator NEAL—No, that was not what Mr Podger told me last time. He told me that the

draft amount provided in the budget was $132.239 million, but that that sum as a whole wouldbe variable, dependent upon negotiations with the states. What I want to know is whether afinal figure has yet been arrived at.

Ms Bennett—There is a final figure that we are using as the basis of negotiations, whichis, as you suggested, $132 million.

Senator NEAL—That is just the budget figure.Ms Bennett—That is the figure we are working off.Senator NEAL—So there has not been a variation?Ms Bennett—No. Though negotiations are continuing.Senator NEAL—So you do not have one yet, is basically the answer. You said that there

are still negotiations going on with Queensland about the funding agreements. What are thedifficulties with Queensland? What is the sticking point there?

Ms Furler —I would prefer not to go into the details of the negotiations between theCommonwealth and the states on the nature of these agreements. They are confidential at thisstage.

Senator NEAL—There is a bit of a problem in Queensland at the moment, and this is whyI asked. With regard to the women’s health program that was previously funded by the

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Commonwealth, which then funded women’s health centres, all around Queensland they havebeen put on a month to month basis. I am concerned that part of the problem with Queenslandis that they do not wish to continue to fund a separate women’s health program. Of course,if that is the case, that is a problem that I think the Commonwealth should be concerned aboutand certainly the parliament would be concerned about it. Is the women’s health programa sticking point with Queensland?

Ms Furler —I am not prepared, as I said, to answer the questions about the Commonwealth-state negotiations in this forum. I think it would really throw into jeopardy the nature of ournegotiations with the states if we were to divulge, in this forum, the particular sticking pointsof the nature of the debate we are having.

Senator NEAL—Maybe I could ask the question in a more general way and then we canavoid that problem. Does the agreement that is being negotiated require the states to retaina separate women’s health program?

Ms Furler —The agreements are focused on the achievement of some priority healthoutcomes for particular groups, for particular diseases or risk factors. The intention is for theCommonwealth and the states to focus on the achievement of those, rather than maintaininga focus on the inputs or the actual way in which some of these outcomes are achieved.Notwithstanding the fact that I am absolutely confident that some of these agreements willcontain some output or process measures, because some of the outcomes are so far down thetrack—we are only talking about a two-year agreement here—certainly, the agreements arenot an attempt by the Commonwealth to dictate to the states that they have to keep in placea particular network of services for particular groups of people, unless there is an exceptionalcircumstance. The whole idea of the agreements is to get us to lift our sights and focus onthe achievement of outcomes, rather than the way in which those outcomes are achieved.

Senator NEAL—I understand that; that was almost the identical response you gave me lasttime. What I am actually asking is: does the agreement provide for the retention of a separatewomen’s health program? If the answer is no, then just say ‘no’.

Ms Furler —No agreement will contain clauses that are about the retention of a particularconfiguration of services. As I said, the agreements are focused on a different—

Senator NEAL—The answers you keep giving me are never quite what I am asking about.That is why there is some difficulty. I did not ask whether they require the attention of aparticular configuration of services; what I asked was: does the agreement provide for theretention of a women’s health program?

Ms Bennett—There is a general clause in all of the agreements for all of the states andterritories which requires the Commonwealth and the territory to continue their commitmentto implement agreed national strategies. There is a list of the agreed national strategies thatstates and territories have signed up to which includes the women’s health policy. So to theextent that states have made a general commitment under those policies, this agreementsuggests that they need to continue that general commitment.

Senator NEAL—Will those strategies be attached to the copy of the agreement that I get?

Ms Bennett—It was not our intention, as they have all signed them separately.

Senator NEAL—Can I have a list of all those strategies that are—

Ms Bennett—Yes, I can read them out to you, if you want.

Senator NEAL—You can read them out or you can just provide me with a list.

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Ms Bennett—I will provide you with a list.

Senator WEST—Can I turn to immunisation? I have a number of questions following upfrom the last estimates. It would appear that we are in a bit of an epidemic of whooping coughat present this year. Would that be a correct assessment?

Dr Mead—Yes.

Senator WEST—So you do not have any further statistics on the number of cases since16 June? We were 3,312 to 16 June for this year. I am wondering if you have got any furtherupdates on the figures.

Dr Mead—They are published each fortnight in theCommunicable diseases intelligence.I do not have the latest issue with me, but that is where they are published each fortnight.

Senator WEST—Any deaths? How many deaths have there been from pertussis this year?

Dr Mead—In the last 12 months there have been six deaths, one late last year. There havebeen five deaths this year.

Senator WEST—And what ages have those deaths been?

Dr Mead—I think they have all been under the age of six months.

Senator WEST—How much of a problem are we seeing with the disease being evident inolder children and young adolescents?

Dr Mead—The number of cases in adolescents and adults is quite significant. An unusualfeature of the reporting of whooping cough in Australia is that we do record a large numberof cases in older children and adults.

Senator WEST—Do we know if these people have never been immunised or whether infact it is because the efficacy of the immunisation has reduced over time?

Dr Mead—In the majority of cases I would think it would be the efficacy of both theimmunity from immunisation and the immunity from previous infection waning over time sothat adults and older children can become a source of infection.

Senator WEST—Hence the need for 95 per cent plus immunisation rates within thecommunity to prevent a reservoir?

Dr Mead—Yes, that is right. And there is also some discussion about whether new vaccinescould be used in older children.

Senator WEST—And there has been no decision made about that yet?

Dr Mead—No, not yet.

Senator WEST—Turning to measles, the number of complications from measles,particularly in relation to SSPE, I asked how many cases had been notified in the last fewyears. You have given me a breakdown since 1990 of the deaths due to measles and the deathsdue to SSPE during that period. I am wondering, though, whether we know how many thereare currently in the community who actually have been diagnosed with SSPE but have notyet died.

Dr Mead—No, I do not have that figure.

Senator WEST—Can you give some indication, for general information, what the incubationperiod is between the disease episode of measles and the onset of SSPE?

Dr Mead—Usually in excess of 10 years.

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Senator WEST—And what is the life expectancy once the diagnosis of SSPE has beenmade?

Dr Mead—Quite short; a matter of months.

Senator WEST—So there is no way of knowing how many diagnoses of SSPE there are?

Dr Mead—Children alive with SSPE?

Senator WEST—Yes.

Dr Mead—No, I do not have that figure.

Senator WEST—Is it not kept?

Dr Mead—I do not know if it would be kept. It would be recorded as a death, but thecondition itself is not a notifiable condition. So we would only know if a case was drawn toour attention.

Senator WEST—There were no deaths in 1994 and 1995. Is that because the notificationof the deaths has not filtered through to the Commonwealth yet?

Dr Mead—No. I think if there had been deaths in 1994 and 1995 we would have recordingsof those.

Senator WEST—It is just that in 1990 there were five, in 1991 there were two, in 1992there were three and 1993 there were two and then we have had nothing in 1994 and 1995.I am just interested in knowing why we have suddenly got to two consecutive years of zeromortality.

Dr Mead—Unless there has been some change in the reporting, that is what the ABSrecords.

Senator WEST—So how do they get reported to the ABS?

Dr Mead—They are recorded through the states notifications of death, so it is the causeof death on the death certificate that is the source of the information. I am not aware whetherthere has been any change in the way that condition would be reported that would lead to therebeing inaccuracies in that figure. So, as far as I know, it is accurate.

Senator WEST—I am wondering whether we are seeing a trend here that is as a result of,say, 10 or 15 years ago a campaign to increase measles immunisation and some relationshipto outbreaks and epidemics of measles.

Dr Mead—It would be possibly a combination of both the effect of increasing immunisationcoverage and the fact that conditions occur in cycles. You might get periods where, becausethere was a low rate of measles 10 years ago, you have a low rate of that condition now.

Senator WEST—In the seven-point plan it says that allowances will be made forconscientious objectors. Can you give me some indication of what the grounds forconscientious objection are?

Dr Mead—The ground is really just the parent declaring that they have a sincere andprofound belief that their child should not be immunised and making a declaration to thateffect. There is also a requirement that they have some discussion with an immunisationprovider to indicate that the risks and benefits of immunisation have been explained to them.The basis of the conscientious objection is that, having had that explanation, the parents stillbelieve that immunisation is not in the best interests of their child and they have a profoundbelief that the child should not be immunised.

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Senator WEST—Have we got any indication yet as to the number of people who are goingdown that path?

Dr Mead—No. We only have information on the basis of surveys of opinion. Survey resultshave shown that 97 or 98 per cent of parents are in favour of immunisation. As the systemhas not yet started to come into effect, we do not yet have any record of conscientiousobjection.

Senator WEST—It is probably dropping every time they see the television advertisementwith the six-week-old baby with whooping cough. Is it compulsory for doctors to notify theimmunisation register of immunisations they administer?

Dr Mead—No, it is not compulsory.

Senator WEST—It says in the seven-point plan, under section 3:A system of incentives and annual awards would be instituted for local councils, GPs and health clinicsproviding immunisation services that record the best immunisation rates. A commensurate system ofpublicly highlighting the worst performing areas will also be put in place.

I am wondering what the incentives and awards are.

Dr Mead—For general practitioners the general practice program is working on a schemethat would provide a financial incentive to general practitioners who achieve a high level ofcoverage amongst the children in their practice. For local government we are looking at somescheme where we can identify some piece of equipment or some particular initiative that thecouncil would like to pursue for those councils that can achieve a high level of coverage. Todate, we do not have sufficient data in a sound enough manner to institute that for localgovernment because the data is still dependent on some glitches in the computer systemsbetween local governments being worked out.

Senator WEST—So it is not compulsory for doctors to notify the register of immunisation.So how is the register going to know that GPs have administered those immunisations?

Dr Mead—If a general practitioner chooses not to participate, then I assume they arechoosing not to be eligible for an incentive payment.

Senator WEST—They choose not to participate but some of them would, as a matter ofcourse, administer immunisations to the children coming to their practices.

Dr Mead—Yes, but if they choose not to have those recorded on the register, then we willnot know about those occasions of service.

Senator WEST—How are we going to know that those children have actually beenimmunised?

Dr Mead—We don’t. We expect that there will be a percentage of immunisations giventhat we will not know about. We offer an incentive to GPs to provide that information. Thereis $6 attached to each occasion of service notified to the register, but a proportion of generalpractitioners may choose not to participate in that.

Senator WEST—How are the parents of those children going to be able to prove to thedepartment, so they can receive their payments, that their child has been immunised?

Dr Mead—They can provide some paper based record of having received the immunisation.The system of payment to parents can either depend on the parents agreeing to the registerbeing checked for their eligibility or they can choose to provide other forms of certificationof immunisation status.

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Senator WEST—So there is not going to be a simple system of each dose of triple antigen,or whatever is given, being registered and the parents being able to front up? They may haveto get pieces of paper and run the risk of that being forged and things like that?

Dr Mead—I think one of the hopeful spin-offs of that system is that the parents would putsome incentive towards the Gps encouraging them to participate in order to make that easierfor them. So that will be an added incentive for the general practitioners to participate in thescheme if their patients are saying it makes it easier for them.

Senator WEST—Has this register commenced yet?

Dr Mead—The register commenced in January last year.

Senator WEST—How many doctors are actually participating?

Dr Mead—I do not have a sheet here that has that, but we can give you the number ofdoctors participating.

Senator WEST—Yes, I would like to know the number of doctors and practices that areparticipating and I would like to know the total number of doctors that are actually practisingfamily type medicine, to be able to compare the numbers that are out there potentially givingimmunisation and the numbers that are actually participating to see what that rate in fact is.

Dr Mead—Yes, we can give you that.

Senator WEST—If we are not getting a great deal of cooperation or participation, then Ithink somebody needs to re-look at the program. Can I turn to the issue of the shortages thatwe canvassed last time in relation to Western Australia. I am advised, in answer question 310,that CSL has advised the department that there was a national shortage of DTP vaccine. DTP,I presume, is diptheria-tetanus-pertussis.

Dr Mead—Yes.

Senator WEST—Is that the same as the old triple antigen?

Dr Mead—Yes. Triple antigen is the brand name.

Senator WEST—Somebody said there is also a new—I have been told—DTP vaccine whichhas fewer side effects coming on the markets.

Dr Mead—Yes.

Senator WEST—Is that available for use in this program?

Dr Mead—We expect it to be available soon for use in the program, but the approvalprocess has not been completed yet.

Senator WEST—At an additional cost?

Dr Mead—We are hoping to be able to include that vaccine in the list of vaccines that areprovided free under the program.

Senator WEST—When will we know this?

Dr Mead—I expect we will know in the next month.

Senator WEST—What is the cost differential?

Dr Mead—Negotiations have taken place with the manufacturers over the cost of thevaccine. There is currently a commercial price where the vaccine is available, but the systemapplying to all vaccines for inclusion on the free list is that a negotiation is carried out withthe Pharmaceutical Benefits Pricing Authority with the manufacturer for a price of that vaccine.

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That price has now been agreed, but the price is such that we need to take the final approvalto cabinet.

Senator WEST—So you cannot tell me what the price differential is at this stage? Whatis the name of the drug?

Dr Mead—The brand name is Infanrix. It is a diptheria, tetanus and accellular pertussis.Senator WEST—It is the pertussis within the triple antigen often is the one that causes the

reactions.Dr Mead—Yes.Senator WEST—Although they are minor in terms of mild fevers and reddening, localised

inflammation.Dr Mead—Yes, the wholesale vaccine, as the name indicates, contains the whole pertussis

cell. With the accellular vaccine, there are selected proteins from the cell which make up thevaccines, so that you do not have those components which are thought to be associated withthose local reactions.

Senator WEST—Have trials been done with this Infanrix to indicate that the side effectincidence is considerably less?

Dr Mead—Yes, the trials that have been conducted prior to the marketing of the vaccine,demonstrate a lower profile of those sorts of side effects.

Senator WEST—This is currently the drug parents choose because they have come froman allergy prone family, particularly where there is a family history of allergy to eggs—I amscratching my memory here from 15 or so years ago—and parents choosing to use Infanrixat present will be up for $30, is that correct?

Dr Mead—That is the ballpark of the market figure. I think some states are purchasing thevaccine for their programs in anticipation of the funding arrangements being sorted out to makeit available for some children who have had some severe side effects.

Senator WEST—It is the Infanrix that would enable this possible trial you talked aboutof immunising for whooping cough at a later age—

Dr Mead—That is only one brand, but there could well be other brands that come on themarket. Yes, it is that sort of vaccine that has been discussed as being possible for use in olderchildren. I think that brand also includes components of diphtheria and tetanus that areappropriate to the younger children. So it would not necessarily be using the same brand, orthe same formulation.

Senator WEST—So you expect that we will know in about a month?Dr Mead—Yes.Senator WEST—In the answer that I received, it says that the shortage was due to a

combination of the following factors:The production lead time for each batch of bacterial vaccine is about 12 months and the rigorous testingrequirements for these vaccines cannot be accelerated.

It leads me to ask what consultations took place with CSL, either prior to the budget of Augustlast year when this program was initiated or immediately after the budget, to ensure that CSLwas actually able to provide adequate amounts of the vaccine so that the program couldcommence.

Dr Mead—Sorry, which program?

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Senator WEST—The immunisation register and the immunisation program. I have noproblems with the program, I think it is very essential. As you know, I spent a number of yearschasing families to have their immunisations. But I am wanting to know what consultationstook place, prior to the budget announcements about all of this, in August last year, either priorto or immediately after, with CSL to ensure that they were going to be able to provide thevaccine in sufficient quantities and the increased number of parents that were, hopefully, goingto avail themselves of the immunisations.

Dr Mead—CSL were involved in discussions with the NHMRC handbook committee thatdetermines the scheduling of the product. They were not involved in discussions aboutparticular media campaigns or the register itself. I am not sure whether they were involvedin discussions about the register itself, because those discussions took place in 1995 and I amnot quite sure. I was not directly involved, so I would have to find out whether they wereinvolved in discussions about things like the register and the fact that the register has remindersin it and those sorts of things. But they are normally involved in discussions about vaccinescheduling.

Senator WEST—Right, because there was a significant ratcheting up of the immunisationprogram following the budget of last year, where it was announced that what used to be theold maternity allowance—

Dr Mead—Those things were announced in February of this year, the announcement beingthat they would start to take effect from January of next year, so there was a high level ofpublicity during February of this year. The states from time to time—and it has always beentheir pattern—when there are particular outbreaks of disease or concerns, make announcementsto try and encourage people to be immunised.

But I am not aware that around the time there was that particular shortage in WesternAustralia that coincided with any of those sorts of events, other than the usual backgroundlevel of promotion.

Senator WEST—You have told me in the answer that the production lead time is about12 months. What consultations took place with CSL to warn them, ‘In February we are goingto undertake this program and, therefore, you will need to increase your stock, you will needto start the manufacturing process to get your stock levels up to cope with what we wouldhope would be a significant increase in the number of immunisations taking place and thereforean increased use in the vaccine’?

Dr Mead—There were no discussions with any of the manufacturers prior to theannouncements made in February about those announcements.

Senator WEST—So manufacturers like CSL were not warned that there was going to bea ratcheting up, an increased demand placed upon their vaccines, a vaccine that takes 12months—from the department’s information that I have been given—lead time to produce?There was no advice given to any of those companies that we were going to actually berequiring their product in hopefully significant increasing numbers?

Dr Mead—I think there has been a long sequence of events promoting immunisation overat least three or four years and maybe we will eventually see information on this from theregister about whether there was any coinciding of the shortage of vaccine in Western Australiawith any increase in uptake. I would doubt it very much because that period of the shortagedid not coincide with any particular campaign activity at all. As I think I said on the lastoccasion, sometimes there are variations in supply around the country that can be evened outand that has been the case with a number of vaccines.

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The actual gearing up of promotion to the community did not start until the end of July ofthis year, and that was the campaign that was announced approximately 12 months previouslyin the August budget. But there has been steady promotion of immunisation and a number ofinitiatives over quite a number of years. We calculate that even the dollars we provide to thestates to purchase vaccine on the basis of agreed high level of coverage—and the states arecontinually in negotiations with the manufacturers about that—are sufficient funds to achieve100 per cent coverage; and that is always the ultimate target. So I do not think there is anycoinciding of the Western Australian problems with any particular campaigning or any lackof information to the manufacturers about the timings of a campaign.

Senator WEST—Within less than six months there had been over 3,300 cases of pertussisfor this year and last year there were only 4,335, to be precise, in a whole 12-month period.From my anecdotal and gut feeling of the community, certainly there are a lot of people whoknew about this episode of whooping cough and there was a lot more publicity given aboutthe February decisions and the August decisions. You do not think that that has had somecontribution to make?

Dr Mead—It is possible, but I think we would need to look at whether the registry dataof the volume of throughput supports that. As I have said, whenever there are particularoutbreaks, states always use that opportunity to promote immunisation. For example, whenthere have been cases of measles recently, all the states have used that opportunity to do anon-the-spot promotion of measles immunisation, and that has not resulted in any particularrun on measles vaccine such that there would be a shortage.

I would be surprised if that shortage was related to a sudden increase in demand that couldhave been predicted on the basis of the timing of a campaign. The sudden demand—if therewas sudden demand as the basis—may have been on the basis of information at the immediatetime because of actual cases. Those actual cases and the publicity around those cases couldnot have been predicted 12 months ahead. Short-term runs on the vaccine in relation to thosekinds of promotions cannot be predicted. It does take us quite a long time to put campaignstogether, so the steady campaigning and the information about that is provided well in advanceto the states, who do the purchasing.

Senator WEST—You say you provide the states with enough money to purchase vaccinesto immunise every child in that state.

Dr Mead—Yes.

Senator WEST—Do we have any idea what the drug companies were doing, if that hasbeen the routine for a significant period of time, in not being able to meet the demand thatthey should have expected?

Dr Mead—No, I cannot answer that. I am not quite sure why, in the production cycle ofCSL Limited, they came across that problem.

Senator WEST—They certainly have not given you any indication as to why—

Dr Mead—They have not given us any indication that the cause of that problem was thefact that they were unaware of any promotions we were doing.

Senator WEST—I would be interested to know why CSL was not able to meet theproduction that was necessary, or not even able to meet the demand, when the states are givenadequate funding to purchase enough vaccine for every child who requires it at that specificage.

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Dr Mead—While there was a short-term low supply then, we do not have any evidence thatCSL did not, overall, meet the demand. As I indicated to you last time, we may have beenable to even out the supplies during that period, had Western Australia informed us that therewas a problem. Overall, CSL did meet the demand but Western Australia had a low supplywhich could have been evened out.

Senator WEST—That raises the question, in my mind: why the hell didn’t WesternAustralia contact CSL and everybody else when they had to send out the alert to all generalpractitioners about a national shortage of DTP vaccine, saying there was only enough to beprovided to clinics? Have we had any answer from Western Australia as to why they did notadvise or did not make a request?

Dr Mead—No, I do not have a specific answer from Western Australia as to why they didnot seek help from us. I think they assumed they could manage the problem quite well. It wasa stock management problem that they could handle.

Senator WEST—They did not think that sending out an alert to every GP in the state mighthave caused one or two of them to ask questions?

Dr Mead—We cannot answer for Western Australia’s actions on that.

Senator WEST—I know. I am just puzzled because they obviously had not told theimmunisation committee that you are on, which has representatives from each state.Presumably, they had not even told their own representative on that that there was a problem.Who was Western Australia’s representative on that committee?

Dr Mead—Western Australia is represented on that committee and that committee did notactually have a meeting around that time when that information was discussed. That committeecan meet out of session or have telephone conferences.

Senator WEST—Who is the WA representative on that?

Dr Mead—Dr Gill.

Senator WEST—It was a Dr Tony Watson who signed the alert, if that is any help to you.

Dr Mead—Dr Watson has, on some occasions, attended that committee.

Senator WEST—The CSL’s press release says the temporary shortage was during April,which is interesting because it was during May that WA was complaining. In your answer on310, you advised that fresh supplies were available to all providers, including generalpractitioners, from 16 May. The general practitioner that I spoke to did not get supplies untilJune. You cannot be responsible for that. It is a family practice which carries substantialimmunisation supplies, as I think I said, and they do a lot immunisations and they did notreceive new supplies until the beginning of June and they had run out of stock.

Ms Murnane—If you give us the name of the practice and indicate what happened inrelation to the supply of vaccine to that practice, we will follow up with the practice and getback to you.

Senator WEST—Okay. New South Wales advised that they had a potential shortage ofmeasles-mumps, didn’t they?

Dr Mead—I cannot recall now.

Senator WEST—Mumps-rubella.

Dr Mead—Yes. But another state had adequate stocks that could be shared if need be.

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Senator WEST—Yes. You advised me of that. One state has advised when it had a possibleshortage; another one has chosen not to. Have any of the other states made any commentsabout possible shortages of any vaccines?

Dr Mead—No.

Senator WEST—In a situation such as these practices in Western Australia that have notbeen able to immunise a child because they have run out of vaccine and the child cannot getto another clinic and in that two, three or four week period that child contracts pertussis andhas complications, side effects and the whole lot, does anybody have responsibility and liabilityfor that?

Dr Mead—I do not think I could comment on that.

Senator WEST—You might like to take it on notice. Would someone have liability? Wouldit be the state health department, CSL, the Commonwealth?

Ms Murnane—Before we start to look at that sort of question, I think we need to get allthe facts on the table about the practices in Western Australia that did not have vaccine insufficient quantities to be able to provide the vaccinations. My understanding is that at themoment we simply do not have that information. I think we need to get that information, lookat it, talk to the Western Australian health department and to the practices involved, and thenperhaps later we could explore the line of questioning that you have just raised.

Senator WEST—I have raised the situation where I have been told by a GP that they wereunable to receive their stocks of triple antigen in this particular case for several weeks. I amasking the follow-on question to that. Irrespective of that particular practice, in a situation likethis where the stocks have run down, who is liable? Is it the Commonwealth? I do not seehow the Commonwealth can be, I hasten to add. Is it the state? Is it CSL? If a child, a nine-or 10-weeker, gets pertussis and they were ready to have their immunisation and could nothave it because there were no stocks and the child gets brain damage as a result—this countryis becoming very litigious—who is going to be responsible?

Ms Murnane—It is incredibly complex and it is certainly not one that we can give adefinitive answer to on the basis of the evidence that you have put before us. What you haveindicated is that there is anecdotal evidence, and we take that seriously. We need to look atthat. The question that you have put in a follow-on from that is a question that would requireus to consult with legal advisers as well as with the various parties that have responsibilityin this.

Senator WEST—I am just wondering, because, as I say, it is an issue that I think is of verygrave concern.

Dr Mead—The issue of vaccines supplied as a result of the questions you raised last timewe did discuss in general terms at the most recent meeting of the immunisation committee,indicating to the states that, if they brought these issues to our attention and to the attentionof their colleagues, then issues of supply could be sorted out more readily. Overall, we arelooking to improve issues of stock control and supply of vaccines in general, but we did notgo into any more detail about this specific incident with the committee, because that is reallya locally based incident.

But certainly we have raised the general issue with the states and some states are lookingto reform their purchasing of vaccines. New South Wales, for example, has recently done amajor audit of their vaccine supply and delivery system. I think states generally are trying toimprove the arrangements they have. But that does not address a particular incident that

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occurred. States generally are trying to improve that and to work with us on sharinginformation about vaccine supply.

Senator WEST—I want to use this incident as an example, not as an example in a nastysense, but to point out to states—because I think the Commonwealth has got a difficult rolehere, because you are providing the states with the money and they have got to go and do it—that we want to send a message to them that it would appear that they have to do somethingwith their stock auditing and control. If giving you a hard time at estimates does that andimproves the immunisation rates across the country, I think it has been an exercise wellundertaken.

Dr Mead—I think it is a fairly recent issue for the states to be arranging deliveries to privategeneral practitioners. I think different states are using different systems for doing this andgaining experience at the moment, as the role of the general practitioners increases. They werepreviously only geared to supply public sector providers. I think the issue of stock control ingeneral practice is quite different because of the low turnover in some general practicescompared to public sector providers. There is a lot for the states to learn about how to managethe stock control.

Senator FORSHAW—I have a couple of questions on immunisation. On the last occasionI asked for some information regarding councils and which ones had ceased to provideimmunisation services. I particularly referred to Sutherland Shire Council in New South Wales,which, I recall, on that day or around the time of the last estimates hearing made anannouncement that it was ceasing to provide that service. You supplied me with informationin that regard. I appreciate that.

The information that was provided indicated, firstly, that in Queensland there are 126 localgovernment areas which collectively provide 30 per cent of all immunisation services in thatstate. Over the last two years, 17 councils have withdrawn from providing childhoodimmunisation services but still provide school based programs. A total of 21 councils havewithdrawn entirely from providing any immunisation services.

You then go on to say—this is still in Queensland—that some of these councils continueto provide support for immunisation delivery such as advertising and promotional material.Could you provide me with a list—I am happy for you to take this on notice of course—ofthe 17 councils and the 21 councils that have withdrawn their services, either wholly or in part,if you know their names? Out of those, which councils continue to provide some support suchas advertising or promotional material? If you would not mind providing that information forme, I would appreciate it.

I have another question, which again is on notice. You referred to Sutherland Shire Councilin New South Wales having withdrawn from providing services. You said that in New SouthWales 15 per cent of all immunisation services are provided by local councils. Is SutherlandCouncil the only council that has ceased to provide immunisation services in recent times?Is that what I should read from that answer?

Dr Mead—That is the only one in recent times, but I gather over the last six years 10councils in New South Wales have withdrawn—over a longish period of time. But SutherlandCouncil is the only one in recent times that we are aware of. We have sought information fromNew South Wales.

Senator FORSHAW—Altogether, how many councils provide the service in New SouthWales? You do not actually say how many there are in New South Wales.

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Dr Mead—I understand that there were 108 councils in New South Wales providingservices. Approximately 10 have withdrawn over the last six years.

Senator FORSHAW—Would you mind providing us with a list of the 108 councils thatprovide the service, the ones that have withdrawn and when they withdrew that service? Monthand year or year would be sufficient, if you could do that. I should also have asked in regardto Queensland if you could indicate when it was that those particular councils ceased toprovide that service. If you have got that information, that would be very helpful. The otherquestion is—I am sorry to put you to this trouble—whether you could give the figures for theother states and territories.

Dr Mead—On councils?Senator FORSHAW—Yes. In other words, I would like to get a picture of which local

government bodies, councils, across the country actually provide the service and their names.Dr Mead—There are some variations from state to state in the requirements under their local

government acts. For example, in Tasmania there is a requirement for the councils to provideimmunisation services. Similarly, in Victoria there are agreements, I understand, between thestate and the councils that govern their immunisation services. So in those two states we arenot aware of any councils pulling out.

Senator FORSHAW—I am sorry to interrupt, but I gather from your answer that, as youonly referred to Queensland and New South Wales, there have not been any other states wherecouncils have ceased to provide the service in recent times.

Dr Mead—We do have some information from Western Australia as well.Senator FORSHAW—Do you understand the nature of the information I am after?Dr Mead—Yes.Senator FORSHAW—Could you provide me with those details?Dr Mead—Yes.Senator FORSHAW—Across the board, what proportion of immunisation services would

be provided by councils? You have said 30 per cent in Queensland and 15 per cent in NewSouth Wales. Can you give us some indicators for the other states and nationally?

Dr Mead—I would have to confirm the figure, but it is well below 50 per cent. I think itis something of the order of 40 per cent.

Senator FORSHAW—Forty per cent?Dr Mead—In Victoria it is quite high, so that balances the average somewhat.Senator FORSHAW—But, even at 40 per cent, that is not insignificant. I would think that

it is a reasonable proportion of the services—Dr Mead—But it is very uneven from state to state.Senator FORSHAW—Yes, I understand that. I do not expect you to respond to this, but

there is a certain convenience involved for people being able to access such services throughcouncil administered programs—without wanting to debate the merits or otherwise—given theaccessibility and things like that. If you could provide that information, I would be grateful.

Dr Mead—Yes.

Senator WEST—Was National Immunisation Day held on 2 August?Dr Mead—Yes.

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Senator WEST—How did it go? What details can you tell me about it?Dr Mead—I could sum it up by saying that it was quite mixed.Senator WEST—With lots of screaming kids, I have got no doubt.Dr Mead—The point to make is that these days are pilot studies. They are not trying to

cover all the areas. The way they were designed was that the states manage the actualprograms with funding from us to appoint coordinators. The states chose the sites they weregoing to use and how they were going to provide the service. There is quite significantvariation state to state in how successful they were in doing that.

We only have very preliminary figures on the evaluation of the days to date, so there isreally no formal evaluation yet. There is quite a significant body of data still to come. Therewere questionnaires given to parents to ascertain things like why they chose to come to theday and what service they normally used—those sorts of things—so that we can gauge whetherthese sorts of services actually attract people who would not otherwise be immunised. We wereperhaps a bit surprised by the number of adults, older people, who came for immunisationservices when we were trying to target small children.

There was also some variation from state to state in the kind of service delivery they chose.On a preliminary look at the figures, where general practitioners were providing the service,only the normal patients of those general practitioners saw it as a service for them, whereasif it was a local government providing a generic service, then it attracted more people. Overall,there were 78 sites offered, but some were much more successful than others.

Senator WEST—How many immunisations were given?Dr Mead—There were 946 individuals.Senator WEST—So if that is the total, some sites would have presumably not seen terribly

many people.Dr Mead—Yes.Senator WEST—And others were run off their feet?Dr Mead—For example, one site in Tasmania—Tasmania only came on board in the last

couple of weeks—saw 40 at one site. In some other states, the number of individuals per sitewas quite low. There is quite significant variation and we do not know yet what we canattribute that variation to—whether it is the organisation on the day, the site they chose—

Senator WEST—The weather.Dr Mead—The weather, the football—it could be a whole variety of things. That is why

we are assessing these things on a fairly strong evaluation design to work out those questionsand also to apply some of the lessons we learnt from this day to the next day.

Senator WEST—When is the next day going to be?Dr Mead—The first weekend in October.Senator WEST—A long weekend in New South Wales.Dr Mead—Yes.Senator WEST—And the ACT.Dr Mead—The idea of offering it then was that if the same sites were used, it would cover

the two months interval.Senator WEST—So you will do another one in early December?

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Dr Mead—Yes.

Senator WEST—When do you think you will have the evaluation?

Dr Mead—I am not quite sure. There is a meeting of the coordinators of the days on, Ithink, 3 September, but we need to collate all the material that will come in.

Senator WEST—As a matter of interest, I would actually like a copy of the evaluationwhen it becomes available, please. Keep us apprised in the lead-up to the days. If there aremembers of parliament near the sites, we can try to assist in engendering a bit of enthusiasm,publicity and whatever else, because it is a vitally important issue.

Dr Mead—Okay.

Senator FORSHAW—I have one follow-up question on immunisation. Going back to whatI was asking about a moment ago, has the department had any discussions or consultationswith the Local Government Association about how it can play a greater part in the nationalimmunisation strategy?

Dr Mead—Yes. We have talked to the Local Government Association, and they are oneof a large number of organisations that we are negotiating with to sign up to a nationalimmunisation charter. Under the terms of that charter, organisations would then develop plansthat would indicate what contribution they want to make to immunisation. The LocalGovernment Association is one of the key players in that strategy.

Senator FORSHAW—I was going back to the Sutherland shire situation, because it is ratherclose to home for me. Every time I get a rates notice now I get a wad of publicity material,including seeking donations for the local Sutherland hospital. I find it interesting. It is certainlya way that publicity can get to every household—certainly every ratepayer anyway—in adistrict. Given that they are also involved in searching for citizenship ceremonies andcommunity based child-care organisations, I would have thought there was a greater role thatthey could play. The issue of funding is always the impediment. I am glad that you are havingthose discussions.

I had one other question back on drugs. Whilst it is not specifically about the heroin trial,and I did indicate to the chair that I forgot to ask it earlier, has the department—Minister, youmight care to respond—or the government developed a position at this stage on the call fora national drug summit? This is something that has some bipartisan support with individualmembers of parliament, as I am sure you are aware, as well as states calling for it. Are thereany plans afoot or attitudes being developed about that at the moment?

Ms Furler —This received some discussion at MCDS. My recollection of the discussion isthat the next phase of the national drug strategy, which would involve several months ofwidespread consultation with non-government organisations, experts, academics and researchersas well as people inside government, would see far more extensive consultation of peoplewithin both the public health and law enforcement sectors, and the holding of a one-offnational summit. The goal of establishing machinery to oversight the next phase of the nationaldrug strategy, which would be far more inclusive of people outside of government—the non-government sector and those stakeholders that I have just mentioned—would also ensure thewidespread involvement of groups that had not been as extensively involved and consultedas they might otherwise have been, which the proposal of a national summit was aiming torectify.

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Subprogram 1.2—Health Regulation

Senator FORSHAW—I think Senator Harradine is on the list, but I am not too sure whetherhe is coming. I have some questions on ANZFA, the Australia New Zealand Food Authority.Firstly, could I take up an issue on behalf of Senator Bob Collins.

Senator Collins asked a series of questions on notice on 24 June which still have not beenanswered. Senator Collins wanted to know when the Australia New Zealand Food Authorityreceived a request from the Australian Quarantine Inspection Service to undertake a full publichealth risk assessment of the proposed importation of cooked chicken meat from Thailand,the United States and Denmark. When did work commence on that assessment process?

Did ANZFA officers conduct the assessment or was the task performed by consultants? Ifit was performed by consultants, what was the cost of the consultancy? What were thequalifications and experience of the officers or consultants who undertook the work? Haveany interim reports been provided to AQIS; and, if so, when were those reports completed,when were they provided to AQIS and what was the AQIS response? Were any of thesereports made available to any other individuals or organisations; and, if so, who receivedcopies of the reports and why were they provided? Can the minister provide copies of theseinterim reports?

Have these interim reports been subjected to public scrutiny or peer review, as is requiredfor quarantine risk assessment processes; and, if so, can details of those processes be provided.Finally, will the final public health risk assessment report be subjected to both peer reviewand public scrutiny before ANZFA makes a final recommendation to AQIS; and, if not, whynot?

I understand that Senator Collins has been pursuing that answer through the minister’s officefor some time and has not yet received a response. He also informed the minister’s office thatthe issue would again be raised at this hearing today. It is question No. 663.

Ms McCaughey—We provided Dr Wooldridge with answers to those questions from SenatorCollins. I do not know whether he has forwarded those.

Senator FORSHAW—So ANZFA has provided answers?Ms McCaughey—Yes, but the answers are for the public record. It is quite a straightforward

story which I am happy to provide here.Senator FORSHAW—Firstly, could you tell me on what date you provided the answers

to the minister’s office?Ms McCaughey—I would have to take that on notice.Senator FORSHAW—If you could, please. Were you advised by the minister’s office that

the matter would be raised today?Ms McCaughey—Not to my knowledge, but we receive many requests that come through

from questions on notice, as I am sure every other departmental officer does.Senator FORSHAW—Could you provide the answer?Ms McCaughey—Certainly. What I might do is refer to my colleague the chief scientist,

Dr Gordon Burch, to go through the background on this.Dr Burch —As the chairperson of the authority has indicated, we have provided detailed

information to Dr Wooldridge. However, from the perspective of the authority, we receivedthe request from AQIS in September 1994 and provided a preliminary assessment of ourresponsibilities under the imported food inspection program at that time. AQIS then undertook

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a number of further consultations, as required under its quarantine processes under theQuarantine Act 1908, and ANZFA has incorporated a number of the outcomes of theconsultations into a final risk assessment, which is currently being peer reviewed andcompleted.

Senator FORSHAW—Thank you. Without going through each part of the 10-part question,do you have an answer in document form that deals with each part of the question?

Dr Burch —We have, on our records, yes.

Senator FORSHAW—That is what you provided to the minister’s office?

Dr Burch —That is correct.

Senator FORSHAW—Are you able to provide that information to the committee now?

Dr Burch —We do not have that information, but we could take the question on notice. Wewould need to seek clearance with the minister to provide that information.

Senator FORSHAW—Okay. Would you do that for me, please?

Dr Burch —Yes.

Senator FORSHAW—If I could turn to the national food hygiene standard, at the lasthearing of the committee you advised that ANZFA expected to have a recommendation onthe implementation of a national food hygiene standard before the ANZ Food StandardsCouncil prior to December this year. Are you still on track to meet that deadline?

Ms McCaughey—Yes, we are. There is a set of four standards and we have alreadycirculated the first two for public discussion and consideration. They went out in May and weare now working on the final stages of the second two. There will be a further period ofconsultation, and we expect that they will go forward to the ministers by about December thisyear.

Senator FORSHAW—With respect to funding of the program and, specifically, thecontribution that the government plans to seek from industry, you advised last time that thatwas being looked at through a separate study. You said that ANZFA had been asked to providea secretariat for this particular exercise, which will also pick up the recommendations fromthe Charlie Bell task force report. Can you tell the committee where that process is up to nowand when you think that exercise might be completed?

Ms McCaughey—Yes. That task force is called the Blair review committee. It was set upby the parliamentary secretary at the request of the Prime Minister, and it arose from the Belltask force. Its brief is to look comprehensively at the food regulatory arrangements acrossAustralia, at the three levels of government and across the agricultural and secondarymanufacturing, processing and retailing side of things to see how we can reduce the burdenof food regulation on industry. But the terms of reference clearly say that the overarchingcontext for this review to try to reduce the regulatory burden is to be public health and safety.So it is in the context of public health and safety.

In answer to your question about progress, the chair was appointed about six weeks ago.The committee had its first meeting last week. It is expected that there will be a discussionpaper coming out of that committee over perhaps the next two or three months to outline howthey are trying to go about their work. It is intended that there will be a series of workshops,public discussions and discussion papers throughout the process, with an interim report goingto the governments probably by the end of the year. It is hoped that a final report will go toCOAG or whatever the meeting will be at that time of the Premiers and the Prime Minister

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by the end of the financial year. The consideration of funding and the way in which industryand government together might contribute is only one part of the whole terms of referenceof that committee.

Senator FORSHAW—Thank you for that. You must have been reading my questions. Youhave answered about the next three.

Ms McCaughey—I am sorry.Senator FORSHAW—Don’t apologise!Ms McCaughey—Those questions are asked very often.Senator FORSHAW—Senator Herron take note!Senator Herron—I am very pleased, so keep going.Senator FORSHAW—Ms McCaughey, who is the chair who has been appointed?Ms McCaughey—The chair is Dr Bill Blair. He was originally, I believe, with the CSIRO

for about 10 years in their research area, but over the last 25 to 30 years he has been involvedin industry. He was formerly, in the last seven or eight years of his career, the managingdirector of QUF Industries.

Senator FORSHAW—I think you said earlier that an interim report will be prepared. Willthat report go to the council of ANZFA?

Ms McCaughey—If I may explain, I am speaking at arms length here a little bit because,while we have been asked to provide the secretariat, we do not run the committee. Thecommittee is under the control of the chair and Prime Minister and Cabinet has set up thebroad terms. At the most recent meeting, it was agreed that they would try to have a firstreport out by the end of this calendar year with the second one out at the end of the financialyear.

The reporting mechanisms would be that the reports would go to ARMCANZ, to ANZFA,to the agriculture ministers and to the health ministers. The final report, when it goes on toCOAG, would hopefully be something that would be agreed on and supported by both setsof ministers because we are trying to cover the whole food supply chain.

Senator FORSHAW—I have some questions about the twice-yearly review of the basisof inspection of imported foods, which Dr Burch referred to at the last hearings. Can someoneat the table tell me what these six-monthly reviews entail?

Dr Burch —I assume that we were talking about the advisory committee that advises theimport of food inspection program. Those reviews by the advisory committee are to examineall matters that are currently under surveillance within the program. If and wherever necessaryfoods that are under a particular category of surveillance might be considered for a changein that category of surveillance, those matters are considered. If a change is felt to bewarranted by the advisory committee, amongst other things, that advice comes back to ANZFAand is considered by the board of the authority. If a change is agreed by the board, arecommendation goes to the minister responsible for quarantine, which is the Minister forPrimary Industries and Energy.

Senator FORSHAW—Can you tell me who makes up the advisory committee and whatexpertise/qualifications they have?

Dr Burch —It is made up of officers from Commonwealth portfolios with the responsibilityand industry persons with expertise. So it is a fairly broadly based committee. I think it hasa state and territory representative as well.

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Senator FORSHAW—Does it have a constant membership?Dr Burch —In the areas of government that are represented or areas of industry that are

represented, then it is constant. But the officers representing those areas change over time.Senator FORSHAW—I was wondering whether specific officers might change.Dr Burch —Perhaps I should take on notice a full list of the membership of the committee.Senator FORSHAW—Would you mind providing us with an outline of the membership

of the committee? Could you also give us a bit more information about the respective areasfrom which they come and what the expertise or qualifications are for each of those people?How comprehensive is that review process? I know that is a pretty general question, but canyou have a stab at it?

Dr Burch —It is one of the steps that is taken in the administration of the import program.The authority has the principal responsibility of keeping the program under review, but thecommittee is there to ensure that, if matters arise in other areas of government or in industrythat need to be taken into consideration, there is a process for that to occur. It is not chargedwith the total responsibility of ensuring that adequate responsiveness is in place for thecoverage of quarantine matters relating to food under the import inspection program.

Senator FORSHAW—The work that they do and the recommendations, the outcomes andthe considerations I presume would carry a lot of weight. It would be regarded as fairlydefinitive, would it not, rather than something that would be likely to be just a first stab orsomething that may be subsequently reviewed by a more comprehensive investigation?

Dr Burch —Certainly we keep the committee fully informed of all of the results of theperformance of the import inspection program and failures, et cetera. It is also a place where,if there are testing procedures that need to be updated, that sort of information comes.However, with respect to individual issues arising from foods that may warrant inspection forthe purposes of protecting public health and safety, then the authority has within its staffpeople skilled to provide that sort of advice and assessment through time. If we feel thatadditional expertise is warranted, then we have the capacity to seek external expert advice.

Senator FORSHAW—I want to turn to a publication that was put out last year inSeptember by ANZFA called ‘Framework for the assessment and management of food relatedhealth risks’. I want to run through some of the principles contained within that documentbefore leading to some questions which are particularly relevant. I take it that this is like theBible—if I can use that term—of the public health risk assessment process. Would that be afair description?

Dr Burch —Yes, it is a policy document which sets out the procedures that we follow indeveloping this document. We have worked closely with international bodies withresponsibility for developing the sorts of guidelines that are reflected in this document.

Senator FORSHAW—To be specific—and I am looking at the contents page at themoment—the body of the report lays out in some detail the proper processes to be followedin public risk assessment, in risk management and in the communication of the risks.

I note particularly that under the heading of risk assessment it lays down the principalprocesses for three areas—chemical risk assessment, microbiological risk assessment andnutritional risk assessment in food. In respect of chemical and microbiological risk assessment,the details are quite different. Am I correct in understanding that these are two separateprocesses of assessment—one looking at chemical risks and another looking at microbiologicalrisks?

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Dr Burch —Yes, that is a correct assessment. The procedures usually associated with achemical risk assessment, which is more akin to long-term chronic exposure to potentialhazards in the food supply, is somewhat different, as you might imagine, to those associatedwith food born micro-organisms where you are usually much more concerned with an acuteoutcome of food born illness. Obviously micro-organisms are subject to control through heator sanitation, et cetera.

Senator FORSHAW—If a finding is made, for instance, that on chemical risk assessmenteverything is okay, that does not say anything about the biological risk that may or may notbe apparent. It does not automatically follow that if the chemical risk assessment is okay themicrobiological risk assessment would also be okay. Is that correct?

Dr Burch —They are certainly separate assessments.

Senator FORSHAW—There is a point as to why I am asking these questions. It helps myunderstanding, if nothing else. As I understand it—and this comes from the document—whilsthazards associated with individual microbiological agents may be well understood, actualinfective dose levels and the effects of food vehicles are less clear. It states that there can beconsiderable individual variation. Am I correct in interpreting that in this way: you reallycannot generalise when you are undertaking a microbiological risk assessment and on a riskmanagement basis. Is that correct?

Dr Burch —That is correct, Senator. Usually for each of the individual micro-organismsthere is an understanding of what level of infective dose might be expected.

Senator FORSHAW—The report also states that the complexity and the risk assessmentprocess is illustrated by the range of specialist professionals involved in the process. Thosespecialist professionals are nutritional scientists, food micro-biologists, food toxicologists andfood technologists. So it is reasonable to state that public health risk assessment and riskmanagement—the basis of this documentation; the principles of ANZFA—are a very complexand specialised process.

Dr Burch —Yes. Obviously a high level of skills is required in each of those areas.

Senator FORSHAW—Bearing all that in mind, can we go through the process that ANZFAis required to follow before it recommends to the council variation to the food code? Couldyou take me through it in a quick summary form?

Dr Burch —That is an issue which might be better provided outside of this forum. I cansummarise, but it is a reasonably detailed process that we undertake.

Senator FORSHAW—For the purpose of the questions that I am going to ask, could wedo it this way: you are required to look at the composition of the food, including the levelsof contaminants or residues that might be in the food. Is that correct?

Dr Burch —Yes.

Senator FORSHAW—You have to investigate the microbiological status and safety of thefood.

Dr Burch —I should clarify whether you are talking about our risk assessment process forimportation of foods or our general variations to the code.

Senator FORSHAW—I am probably talking about both. One question that is going to ariseis what standards we apply with respect to the importation of food and how that relates to whatwe do internally, if I can put it that way. I think you can see where I am leading.

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Dr Burch —I should make it clear that there is a difference between our responsibilitiesunder the imported food inspection program in conducting a risk assessment to those of theauthority in varying the food standards code. The difference is this: under the imported foodsinspection program all food is inspected against the food standards code—that is, the standardsthat are currently established and maintained by the authority.

The inspection is governed by three categories of inspection: risk level, active level andrandom level surveillance. I will not go into the detail but I can provide information on that.In the case of AQIS’s work on chicken meat, for example, where AQIS is intending to importa food which has not been currently the subject of an inspection process, they seek advice forus as to what level of inspection in those three categories it should fall.

That advice is only advice which comes into effect after the decision has been made byAQIS to recommend importation of the food. That is quite different from the process that weconduct in our normal process of changing the food standards code, where we have an all-embracing responsibility to look at all aspects of a proposed change in the food standards code.

Senator FORSHAW—Thank you for that because that is where I was leading to: to thedistinction which I understand exists. I want to go back to the process for food produced inAustralia. As you just indicated, it is a more thorough process. I am trying not to put valuejudgments on it at the moment. For instance, you are required to investigate the actualproduction of the food, including the additives that are used, the packaging, the storage, thehandling, labelling, promotion and advertising. They are all elements that you would need toconsider in the overall process. Is that correct?

Dr Burch —Yes, that is correct.

Senator FORSHAW—It is a very open and comprehensive evaluation process in accordancewith these guidelines, is it not?

Ms McCaughey—As Dr Burch has said, there are two processes. One is the process forsetting a standard, and then the states and territories monitor how the food is produced andwhether it is produced according to those standards. We have a formal statutory open processinvolved in setting a standard for a food product. I think that is one thing.

Then there is the process which is quite separate and which is not set down as part of ouract per se. The act says that we will provide this policy advice on imported foods to thequarantine authority. That is a process that is set up which is also thorough, but it is a verydifferent process to the one in which we call for consultations and go about the business ofsetting a food standard.

Where the misunderstanding seems to have occurred is that somehow we influence thedecision on whether things shall be imported or not. That is the responsibility of the quarantineauthority. What we do, as Dr Burch has said, is give policy advice on what sort of surveillancemeasures should be put in place once they have made that decision and decided to let theproduct come through. I think it is a distinction that seems to have got blurred, but that is ourrole.

Senator FORSHAW—I am trying to get a better understanding of this distinction. Aquestion arises as to whether or not the distinction and the processes should be so differentand just how thorough the process is with respect to the importation of food vis-a-vis therecent problems and debate about cooked chicken meat, which I am going to come to.

One of the things that has to be done, as I understand it, under the process for looking atfood manufactured and produced within Australia is that, if there is to be a variation of the

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food code, the proposed assessment has to be published in theGazette, submissions sought,a draft report prepared and released for public comment and a final report prepared andreleased. Project teams can then be established to bring in all the expertise. Those requirementsare written down in the ANZFA Act; is that correct?

Ms McCaughey—Yes.Senator FORSHAW—As I said, it is a very thorough process. I want to turn again to

imported food. Section 7J of the ANZFA Act requires ANZFA to ‘develop assessment policiesin relation to food imported into Australia’. Is that correct?

Ms McCaughey—Yes.Senator FORSHAW—We have been advised in the past that that process involves a review

of relevant literature and the allocation of imported food into one of three categories—low,medium or high risk. That category then determines the sampling of the product that wouldbe undertaken.

Ms McCaughey—The authority to make the decision about the food coming in is vestedin AQIS. Once they have made that decision, we provide the policy advice on what sorts ofassessments should happen from there on in. In other words, in which of those three categoriesDr Burch referred to it should be listed. This is very much a scientific based matter. It is thena matter of what measures we should put in place to keep checks on things and how frequentlyit should be checked.

Senator FORSHAW—Who does the assessment on whether it is low, medium or highrisk—AQIS? Is that what you are saying?

Dr Burch —No, the authority assesses.Senator FORSHAW—That is what I thought.Ms McCaughey—They provide that advice to AQIS to do the assessment, on the basis of

which AQIS then does the assessment.Dr Burch —But that is after a decision has been made as to the importation or not of the

food. That does not influence the decision making process.Senator FORSHAW—Can you tell me in broad terms how commodities break down into

low, medium and high risk? What is the determinant for making those decisions, without beingtoo scientific about it?

Dr Burch —It follows the protocols set out in our document that you have referred to.Basically, if there is a possibility that food born organisms which could cause acute illnessin humans might be found, and there would be a concern that either in the actual processingof the food or more likely post-processing in the transport and the importation of the food thatsome post-processing contamination could occur, if ANZFA feels one or more organisms maybe of concern to human health and safety, it might be assigned to a high risk category.

If there is some doubt as to whether those organisms are likely to be there or not, then weput it into the second category, which is an active surveillance so there is a watching brief.If we do detect some of those organisms, it automatically goes up into the high risk categoryand will remain there until there is adequate performance demonstrated through the importationof the food over a period of time.

Senator FORSHAW—How many product lines entered Australia last calendar year?Dr Burch —We would have to take that question on notice. Are you referring to chicken

meat?

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Senator FORSHAW—No, all over.

Senator WEST—I hope no chicken meat came in.

Senator FORSHAW—I have a figure of 78,000.

Ms McCaughey—We would have to take that on notice.

Dr Burch —You are talking about all possible food products—canned, fresh, et cetera.

Senator FORSHAW—We will see whether your answer gels with ours. I am also advisedthat, of the 78,000, approximately 25,000 were referred to AQIS officers to request forquarantine and health risks. Under the imported food control regulations, risk foods aresampled at certain rates. Can you confirm this for me? Six samples from consignments of upto 4,800 packages and 13 samples from consignments of 4,800 to 24,000 packages. Can youconfirm that?

Dr Burch —Again, these are AQIS and Customs sampling regimes. I think the safest thingwould be for us to take on notice as to what rates they are using for different food products.

Senator FORSHAW—You might also respond to this or take it on notice. From the advicethat I have been given, consignments having five per cent faulty packages would be acceptedas sound under this sampling method on about two out of every three times. Consignmentswith one per cent faulty packages would pass inspection nine out of 10 times. One wouldassume from that—correct me if I am wrong—that given the cluster of faulty packages therate of detection would be lower and, therefore, the chances of contaminated product enteringAustralia higher. Do you have a view on that?

Dr Burch —I should make it clear that those sorts of sampling regimes are usually lookingfor labelling failure rather than contamination, although in the sampling regime if it is apackage food—

Senator FORSHAW—These are sampling of risk foods, as I understand it.

Dr Burch —If it is in the risk food category, there are within the sampling regimes a seriesof switching rules, where after a number of shipments of no fault being detected they switchto a low level of surveillance. Then these sorts of levels of testing come in. Again, these areunder the administration of AQIS, not under the administration of the authority. I am happyto take the question on notice, but in effect it is an AQIS response.

Senator FORSHAW—I am happy for you to do that, and I would appreciate a response.Given the requirement under the act that I referred to earlier for ANZFA to develop assessmentpolicies in relation to food imported into Australia, is ANZFA looking at any ways of tryingto improve this process?

Dr Burch —Yes. We analyse all of the data that you are talking about. All of the failuresthat come in we look at quite closely. If there are any questions as to the methods of detectionor whether a sampling regime is adequate or not, those questions are examined constantly bythe authority in providing its ongoing advice to AQIS. We are often assisted in that by theAustralian Government Analytical Laboratories.

Senator FORSHAW—If you could provide that information, I would be pleased. Dr Burch,you advised the committee in June that the role of AQIS in the public health risk assessmentprocess was ‘to provide us with adequate information to ensure the microbiological safety ofthe food, and to that end they provided the temperature regimes a product would be exposedto’. That is the role of AQIS. Is that all you require from AQIS?

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Dr Burch —Except for the probably assumed information on the actual products that arecoming in, then our role is to look at the step of the processing of the food—in this case, thecooking process, to assess whether organisms that we might have identified as being ones ofconcern would have been adequately controlled. Our advice on the risk categorisation takesinto account, if possible post-processing contamination could occur, what sorts of organismsmight have been contaminated on the cooked product.

Senator FORSHAW—Outside of that, all the other information that ANZFA would requireto undertake its assessment of the public health risks—and I am referring specifically to eithercooked chicken meat or cooked pig meat—other than what you have just referred to, wouldhave been a matter directly for the authority. Is that correct?

Dr Burch —Yes, except that through our advisory committee and through our interactionwith AQIS, if we share information on likely patterns of food born pathogens that might beoccurring in different parts of the world, AQIS is often informed of that sort of information.We seek independent advice ourselves from other food regulatory bodies elsewhere in theworld when we are conducting these assessments.

Senator FORSHAW—I want to turn to chicken meat and pig meat. I would like to asksome questions about the public health risk assessment that you have completed on theseapplications to import cooked chicken meat and cooked pig meat. In answer to a question onnotice from the last hearing you advised that imported food must comply with the provisionsof the foods standards code. You also said that relevant scientific papers and reports providedadequate information to support ANZFA’s recommendation that imported cooked pig meatbe risk categorised under the IFIP. I assume that was also the case for chicken meat, was it?


Senator FORSHAW—So you did a literature review and on that basis categorised theproduct accordingly.

Dr Burch —That is correct, and any other information that we could obtain.

Senator FORSHAW—In this case what would be ‘other information’ besides the reviewof all of the literature that was available or that you were able to have regard to?

Dr Burch —In the case of chicken meat or pork meat, there are publications that areconstantly being updated. For instance, in the USA there is a constant reporting process whichidentifies the prevalence of certain organisms; it also identifies whether there has been anychange in the nature of those organisms. That information is often more recent than you mighthave got, say, through perhaps the more traditional literature. So we keep making certain thatwe have the most recent information available to us.

Senator FORSHAW—Based upon the literature and the additional or other information—which sounds to me like an update of what might have been in the literature anyway—presumably you were able to tick off on the checklist the various elements that needed to beconsidered. Is that correct?


Senator FORSHAW—Perhaps we might just go through that checklist quickly so that itis on the record. You identified all the potential hazards in both products—cooked chickenmeat and cooked pig meat?

Dr Burch —We have identified that in our risk assessment.

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Senator FORSHAW—Given that these products are being sourced from a number ofdifferent countries—for instance, the pig meat from Thailand, USA, Denmark and Canada—wouldn’t it have been a pretty big task to identify all those potential hazards?

Dr Burch —I think you are talking about chicken meat there.

Senator FORSHAW—I am sorry, I thought it was pig meat. If it is chicken meat, it ischicken meat. It is the same issue in many ways.

Dr Burch —Yes. As I say, we look carefully at organisms that might be prevalent indifferent countries.

Senator FORSHAW—In regard to chemical contamination, is it your view that adequateresearch has been undertaken already into all the chemicals used in all those source countriesthat accords with OECD procedures, or that has been subjected to peer review or publishedin internationally recognised scientific journals?

Dr Burch —The food standards code is very comprehensive in setting out the levels whichare permitted in Australian food. That includes contaminants, such as heavy metals, that mightbe present in the food. It also extends to possible chemicals, and it also extends to residuesof agricultural and veterinary chemicals. All of these are specified.

The testing simply tests against the presence of those chemicals. If there are chemicalsdetected which are not specified within our food standards code, then the food would beadulterated and would not be permitted to be imported.

Senator FORSHAW—But the tests that I am referring to here are the ones, as I understandit, that are applied to any scientific data to be used in a public health risk assessment process,as per the document that I referred to earlier—the framework.

Dr Burch —Yes, but this is where you have to be very careful. There is a clear distinction.As I said earlier, the food standards code contains specifications which are developed throughthat very comprehensive process that we spoke about a moment ago and which is reflectedin the document you are talking about. The food standards code therefore reflects, if you like,accumulated wisdom, both that obtained within Australia and that obtained from overseas.

That is quite different to the process that is occurring in the importation of the food wherethe tests relating to chemical contaminants are held against the specifications in the foodstandards code. Therefore, ANZFA, in terms of any sort of further comprehensive examinationof chemical contaminants, really is not required under the IFIP program to raise additionalmatters because it is already covered under the inspection arrangements that are there already.

Senator FORSHAW—I still have quite a few questions to go on this issue, but I am aboutto turn to a slightly different aspect of the questioning. So, if you are wanting to adjourn,perhaps it might be convenient to do so now.

Sitting suspended from 12.30 p.m. to 1.37 p.m.

CHAIR —Before I call Senator Forshaw, I believe Dr Burch has documents that he wouldlike to have incorporated inHansardand provide the committee with.

Dr Burch —Senator Forshaw sought some responses to questions on notice from SenatorBob Collins. I have checked with the minister’s office and the minister is happy for theanswers to be incorporated inHansard.

The documents read as follows—

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(Question No. 663)Senator Bob COLLINS asked the Minister representing the Minister for Health and Family Services,

upon notice, on 25 June 1997:(1) When did the Australia New Zealand Food Authority (ANZFA) receive a request from the

Australian Quarantine and Inspection Service (AQIS) to undertake a full public health risk assessmentof the proposed importation of cooked chicken meat from Thailand, the United States and Denmark.

(2) When did work commence on that assessment process.(3) Did ANZFA officers conduct the assessment or was the task performed by consultants.(4) What was the cost of the consultancy.(5) What were the qualifications and experience of the officers or consultants who undertook the work.(6) Have any interim reports been provided to AQIS; if so: (a) when were those reports completed;

(b) when were they provided to AQIS; and (c) what was the AQIS response.(7) Were any of these reports made available to any other individuals or organisations: if so (a) who

received copies of the reports; and (b) why were they provided.(8) Can copies of these interim reports be provided.(9) Have these interim reports been subjected to public scrutiny or peer review, as is required for

quarantine risk assessment processes; if so, can details of those processes be provided.(10) Will the final public health risk assessment report be subjected to both peer review and public

scrutiny before ANZFA makes a final recommendation to AQIS; if not, why not.Senator NEWMAN—The Minister for Health and Family Services has provided the following answer

to the honourable senator’s question:(1) A formal request was received from AQIS on 5 September 1994 to do a risk assessment rather than

a full public health risk assessment. The ANZFA risk assessments are done in the context of the ImportedFood Control Act (IFCA) and are secondary to the quarantine assessment. In effect, ANZFA is asked,given that this product may be allowed into Australia, what kind of risk management strategies will benecessary. ANZFA advises on appropriate surveillance categories and testing regimes but banning aproduct is not an option within the scope of the IFCA.

(2) In July 1994.(3) ANZFA officers conducted the assessment.(4) N/A.(5) All staff contributing to the work have appropriate tertiary qualifications, with extensive experience

in the Imported Food Inspection Program including undertaking risk assessments.(6) One interim report was provided to AQIS.(a) The interim report was completed on 7 September 1994;(b) The interim report was provided to AQIS on 7 September 1994;(c) AQIS responded by summarising the report in the AQIS Policy Memorandum 96/32, which was

circulated for comment on 7 June 1996.(7) The interim report was summarised in AQIS Policy Memorandum 96/32 and made available to all

interested parties. The report ss as not made available separately from the AQIS document.(8) Yes, a copy of the correspondence to AQIS, dated 7 September 1994 can be provided. In summary,

the report concluded that cooked chicken meat will be subject to the highest level of surveillance in theImported Food Inspection Program for bacterial contamination by Salmonella spp, Listeria monocytogenesand Campylobacter spp. Testing for antibiotic residues and organochlorine/organophosphate residues wasalso discussed.

(9) The interim report has been subjected to public scrutiny as part of the AQIS Policy Memorandum96/32 which was circulated to interested parties. All ANZFA risk assessment reports are peer reviewedinternally by the various scientific discipline groups represented within the organisation. All riskassessments dealing with microbiological matters are reviewed by the microbiological discipline group,

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assessments dealing with toxicological matters are reviewed by the safety assessment discipline groupand so on. The final report is currently being externally peer reviewed by the CSIRO.

(10) The final risk assessment will be subject to peer review before ANZFA makes a finalrecommendation to AQIS. The final recommendation to AQIS will be available to the public but willnot undergo public comment independently of the AQIS processes.

Senator FORSHAW—I want to return to the issues that we were discussing before lunch.Dr Burch, can you advise the committee whether or not the data you relied on in relation toeach product in each country was from one source or from a number of sources?

Dr Burch —The risk assessment we conduct is on the basis of the organisms that have beenidentified. Most of the information that goes into the risk assessment is associated with theparticular organisms and their behaviour and their control under the stipulated conditions of,in this case, the cooking of the products.

Senator FORSHAW—Can you in general terms identify the instances where the data wasin fact drawn from a number of different sources and advise the committee how you go aboutdrawing all that data into a useable form? What approach do you follow before you respondto AQIS?

Dr Burch —As I indicated, the risk assessment goes through a period of development wherewe consult with AQIS on to the organisms they might have identified and that we might needinformation on. As you have indicated, we conduct literature research and we obtain the mostrecent information from overseas. Where necessary we would also seek advice frommicrobiological specialists within Australia or even perhaps outside Australia. Together thatinformation is incorporated into the risk assessment.

Senator FORSHAW—Is ANZFA the agency that looks at chemical use from the publichealth perspective or is it another agency that does that?

Dr Burch —It is in two parts. The registration of chemicals that are used in Australia foragricultural and veterinary purposes are registered under the National Registration Authorityfor Agricultural and Veterinary Chemicals. They set what is called a maximum residue limitwhich is on the basis of good agricultural practice. Those limits are usually well below anypossible concern for public health and safety. Then they apply to the authority for thoseresidue limits to be established within the food standards code and then we conduct our normalpublic assessment process.

Senator FORSHAW—Can you confirm that ANZFA consulted with the NationalRegistration Authority about the matter of chemical contamination prior to giving a clearancefor cooked chicken and pig meat?

Dr Burch —Yes, to the extent that ANZFA has the responsibility of listing chemicals whichare permitted within the food standards code—and we certainly have that information at ourdisposal. Often there are other chemicals that are identified in use in other countries and wewould consult with the Registration Authority about such possible chemicals. The RegistrationAuthority in conducting their particular responsibilities also seek advice from the departmentof health which has a chemical toxicology unit where they assess public health risks of specificchemicals. The Registration Authority also consults Worksafe in terms of the safety of thehandling of those chemicals.

Senator FORSHAW—To save a bit of time, I will ask you to take the following questionson notice. I am sure you will have to get the information. I will read them intoHansard. Whatis the extent of use of chemicals in the processing of cooked chicken meat and cooked pigmeat? Could you provide a list of those chemicals and their use? Can you also advise the

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committee of the status of use of these chemicals in Thailand, the USA, Denmark and Canada?Specifically, are any of them banned here? If not, what restrictions are placed on their use hereor in the countries mentioned? What are the labelling requirements associated with their use?

In relation to agricultural and veterinary chemicals, can you advise the committee what theminimum residue levels are in Australia and if there are any minimum residue levels in thesource countries? Can you also advise the committee of the maximum permitted concentrationof any environmental contaminants identified in any of the source countries for both theseproducts? Was there sufficient detail in the existing literature of the dose levels of allchemicals used? Can you also confirm that there was an adequate analysis of the metabolismand kinetics of the substances used? You can take those on notice because they require somedetails.

I note that domestically you have general guidelines for establishing the profile of chemicalsin food, such as food additives, processing aids, food contaminants, et cetera. These profilesare generally undertaken by the companies and then submitted to ANZFA, are they not?

Dr Burch —In terms of the food additives, the company would make application to us ifthey seek to have a new food additive used in the processing of a food in Australia or for thatmatter imported into Australia. If it is an agricultural and veterinary chemical, then it wouldbe the company’s responsibility to seek registration of that chemical through the NRA.

Senator FORSHAW—Were the companies that were planning to export chicken and pigmeat to Australia required to undertake such profiles? If so, have they been or will they beevaluated by ANZFA?

Dr Burch —If a country exporting a chicken meat product identified an agricultural andveterinary chemical that was in use in that country which was not registered for use in Aus-tralia, they would have to make application through the National Registration Authority andultimately that would be assessed by us before it would be a listed chemical at a specific level.Only after such time could a product which contained the residue of that chemical come intoAustralia.

Senator FORSHAW—Have you received or requested copies of evaluations which havebeen made in other countries?

Dr Burch —That is the responsibility of the NRA. They have a series of protocols with othercountries where they exchange information.

Senator FORSHAW—Does ANZFA request that they then be provided to you?Dr Burch —They are, as a matter of course, provided to us in seeking an application.Senator FORSHAW—I also have some questions with respect to the microbiological risk

assessment, which you can take on notice. These are similar to the ones that I asked you earlierwith respect to chemical risk assessment. Rather than read those into theHansard I willprovide those to you in writing. That will save a bit of time.

What all this is leading to, as I am sure you would have guessed by now, is the issue ofwhether or not the processes and standards we apply in a public health risk context to importedfood are the same as or as stringent as those that we apply to locally produced food. As youhave said earlier, I understand that there are different processes that are followed. Given thatimported food is probably likely to be far more susceptible to food born disease than thatproduced locally, what if anything is ANZFA doing about trying to overcome these problemsthat have manifested themselves in the cooked chicken meat and cooked pig meat examplesto try to get as uniform as possible standard to that which we would apply in Australia? Do

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you think that is a primary objective? I go back to the earlier point about the legislation thatit is ANZFA’s responsibility to develop processes which ensure public health safety in respectof imported food.

Dr Burch —The answer is probably in at least two parts. The first part is that the importedfood inspection program was developed jointly between AQIS and ANZFA. That was aresponse by ANZFA to put in place a process which was consistent and delivered the samelevel of health and safety outcomes at the import barriers as might be being achieved in thedomestic market. In achieving that we need to be clear that the same standards apply at theimport barrier—that is, the food standard code—as apply in the domestic food supply.

Under our world trade obligations, as a signatory to a number of agreements, we have toensure that the same level of standard and surveillance is applied to imported food as is appliedto food in the domestic market. The inspection regime that we set at the import barrier takesinto account the level of surveillance and monitoring that the states and territories carry outunder their jurisdiction of enforcing the food standards code in the domestic situation. We haveto be careful that that level of surveillance is not to the point where it could be contrived tobe not consistent with what was being done at the domestic level and therefore subject toWorld Trade Organisation challenge.

Senator FORSHAW—I am conscious of time and I have some other important matters todeal with which I will place on notice rather than read out to you. They relate to the code fortreated refrigerated foods and the transportation of products into the country. Could I now turnto the hazard analysis critical control point system which was something we asked youquestions about on the last occasion. How long will it take to have a safe and effective systemup and running in, let us say, the export meat sector?

Ms McCaughey—Because of the division of responsibilities between Primary Industriesand us in terms of the various aspects of food regulation, we are primarily responsible forcoordination of the domestic food supply. AQIS and other parts of DPIE manage what goesacross the borders.

Senator FORSHAW—Can you answer the question generally. If I have picked ademarcation line that you do not want to step over, I appreciate that.

Ms McCaughey—In relation to the export area, that would be properly asked of AQIS. Inrelation to the hygiene standards that we have talked about at the previous hearings, the healthministers will be, as we said earlier today, receiving the draft hygiene standard at the end ofthe year. It is up to them then whether they wish to adopt that into state and territorylegislation. Once the ministers decide to allow that to be gazetted, we are looking at a periodin which people get used to it and get to know and understand it, and it will be phased in overthe next few years.

If that sounds a bit vague, I am sorry. It is a huge new undertaking. If you think about thehundreds of thousands of food businesses that are involved, what will be asked of them is thatthey develop food safety programs, that they have those food safety programs audited by athird party and that their staff have the training that is commensurate with the level of risk.I guess it is one of those things, that we have to embark on it before we can really understandthe extent to which additional initiatives or resources are going to be required.

For example, the area of training will require the food businesses to be assessing the extentto which their staff have the level of skills that are needed for the risk that is there and willrequire all the training bodies around the country, through the ITABs, to be assessing theextent to which they have currently got the capacity to deliver training should that be required

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of particular food businesses. Those processes are under way now with ANTA conveningmeetings with the ITABs to discuss training requirements for example.

Senator FORSHAW—This is a major part of ANZFA’s work over the next few years?

Ms McCaughey—Yes, definitely.

Senator FORSHAW—I referred to the export meat sector. You quite properly raised theissue of the delineation between ANZFA and AQIS. If I can return to that because, as Iunderstand it, it is anticipated that a system would be able to be developed and up and runninginside of three years in the meat industry. As I understand it, hazard analysis critical controlpoint system use is to implement a system whereby rather than end product testing you areputting into place control mechanisms and so on at steps in the process. In the context of themeat industry, whether it is for domestic consumption or export, I assume that the process,when it is developed, will still be applicable right across the industry irrespective of wherethe product is intended to ultimately go.

Ms McCaughey—As I think you are aware, there are meat hygiene regulations that havebeen developed by ARMCANZ. The state and territory agricultural bodies have adopted thatlegislation. That is under the responsibility of the agricultural portfolio. While we make it ourbusiness to make sure that we are working from the same principles and are not incompatiblewith one another because of the need to go across the food supply chain, I am sorry but Icannot give you the details as to what time lines DPIE is operating to there.

Senator FORSHAW—If you can find that out and give it to me later, that is fine. On thelast occasion Dr Burch indicated that this system is now the internationally agreed processingstandard for food hygiene. A number of countries, particularly countries in Asia, are apparentlyendeavouring to develop such systems in their own processing industries and are running intosome problems in that regard. Are you aware of some work done by the Department ofAgriculture in Thailand on the difficulties faced by developing countries in developing sucha system?

Dr Burch —I need to take the question on notice to give you full details. We do keep incontact with particularly the FAO that conducts a series of workshops in the Asian region.At those workshops countries do bring issues that they have in terms of appropriately andadequately introducing hazard regimes.

Senator FORSHAW—I would be surprised if you were not. I will provide the details. Iam endeavouring, as I said earlier, to move through the remainder of this fairly quickly ratherthan keep everybody sitting here for hours. But there was a paper presented to an internationalconference in Holland in February this year.

Dr Burch —I know the conference.

Senator FORSHAW—It was on this very issue of the problems being faced by developingcountries. It was presented by an officer from the Thai Department of Agriculture. Therelevance of raising this is—and my questions on notice will go to this—given that they aretrying to set up this system in their countries and ANZFA is involved in trying to set thissystem up here as the new all embracing system of monitoring, assessment and control toprevent food contamination and so on, and given that there was a proposal to import cookedmeat from Thailand, the question arises as to what regard was paid by ANZFA and/or AQIS—you may not be able to answer for them—to that issue and whether or not the processes thatled to the ultimate recommendation were adequate, having regard to the state of play in thecountries where the product was coming from.

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Dr Burch —That is really the responsibility of AQIS. We do not have a role or functionin establishing processes. We give advice. But, in relation to the inspection regime in Australia,you are probably aware that AQIS does establish certification arrangements with countries thatare seeking to export food to Australia and they have a procedure by which they inspectprocessing plants in those countries to ensure the safety and quality of the food. That reallyis a responsibility of AQIS and should be directed to them.

Ms McCaughey—We do not have any involvement in that process. That is the basic factof the matter.

Senator FORSHAW—Does ANZFA have a view about whether or not this system shouldhave been in place before we considered importing cooked meat? I am advised that there isno such system in place in any of the chicken processing plants in Thailand.

Dr Burch —I think we do not actually provide a view. That is really the responsibility ofAQIS to deal with the importation of a food. In terms of our responsibility, irrespective ofwhat steps AQIS may have taken in having assurance schemes with another country, we stillhave in place the inspection regimes that we have recommended under the IFIP program. Tosome extent, that is an assurance that, if necessary, 100 per cent of the product that comesinto Australia will be tested for safety.

Senator FORSHAW—Given the involvement of ANZFA—I am not sure how many knowabout the existence of ANZFA; you do not get as much publicity as AQIS—in a fundamentalway in developing a new national food hygiene standard and all the work that you have toldus about previously that is taking place, I would have thought that the average person in thestreet or in the supermarket would be concerned, when it comes to a critical issue like this,that you do not have a direct role in considering what the standards should be that are appliedin other countries with respect to food that we are going to import, given that your obligationunder the act is to develop processes or systems which relate to imported food.

Ms McCaughey—Perhaps I can answer that in two ways. The point is that ANZFA’s jobin relation to the food product standards is to develop those gold standards. Anything comingacross the border has to meet those gold standards, the Australian standards. That is our primejob. What the health ministers have also asked us to do is develop what they are calling astandard for hygiene, but in fact that standard will replace the hygiene regulations eventuallywithin the states and territories. If you like, it is more by way of a national standard as to howthe regulations should be conducted in the states and territories.

Australian governments are not in a position to tell governments in other countries how theyshould meet the food product standards. But what we can do is to say, ‘Food cannot comein unless you meet those food product standards.’ I guess it is really important to distinguishbetween the gold standards for what can be in a food product, and unless the food productmeets those standards it cannot come across the border, and the hygiene standards forprocessing and handling, which are not part of our act per se. We are not told that we haveto develop those. The health ministers have said to us, ‘Develop a standard for the hygienehandling which we want to take the place of the hygiene regulations in our states andterritories so that we have a uniform set.’ I am trying to draw that distinction for you.

Senator FORSHAW—I appreciate the distinction. I appreciate that you cannot resolve myconcern and it is probably getting a bit beyond what we are doing today. The problem is thedistinctions that are being made when, at the end of the day, the issue is whether or not thequality of the imported food meets the standards. That must include an assessment of whatprocedures are in place in the exporting country.

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Ms McCaughey—If the micro-biological standard is met by the country that is selling theproduct to us by whatever method, as long as the product has met the gold standard for whatcan pertain in this country, it is not seen as the business of this government to determine bywhat method they arrive at that standard. I think that is the distinction for us.

Senator FORSHAW—On the last occasion you advised the committee that you had onlyjust received a copy of the report of the fish and fish products task force. Can you give usan update on what has happened to that?

Dr Burch —We provided advice after the last hearing on the two reports that had beenprepared. I would have to take the question on notice. There has been no further informationor responses sought from ANZFA at this stage. Where exactly the Fisheries ManagementAuthority or the Fishing Council is with those two reports I would have to take on notice.

Senator FORSHAW—I might say that it is a matter of concern to us. It appears you havea very limited involvement in the process so far. I have some further questions on importedpig meat which I have put on notice. There was a story on Channel 9’sSundayprogram on6 July about unsafe food practices found in a survey of meat outlets in Sydney and Brisbane.There were high levels of E. coli in the meat. The survey also found examples of unhygienicpractices in supermarkets and restaurants. Are you aware of that program?

Ms McCaughey—Yes. That was drawn to our attention.

Senator FORSHAW—Have you undertaken any inquiries as a result of the problemsexposed on that show?

Ms McCaughey—I think it goes further than that. The concern that the public has beenexpressing about hygiene standards—small ‘s’ standards, if you like; the standard of hygieniccare of food processing and retailing—has led to the commitment of nine health ministers thatwe should be asked to develop a uniform preventative hygiene standard.

In answer to your question, what we have done following that, I suppose, is to continue thepressure on the states and territories and businesses to try to get agreement to these newhygiene standards. That will put the responsibility for food safety much more clearly andovertly, I think, onto food businesses. They will be required to do food safety programs, tomonitor the food safety programs and to have them audited by a third party, and that will bebacked up by random audits by government. That is the proposal.

Senator FORSHAW—Finally, the program referred to data from ANZFA, as I recall it,that estimated that each year two million people are struck down by something they haveeaten—that is an average of 5,500 people per day. Is that an accurate reflection of your data?

Dr Burch —That is a publication that we have used in our various information papers andpublications that we have prepared. It is a study conducted out of the Melbourne diagnosticunit. The two authors are Veitch and Hogg. These are very ballpark estimates but they are thebest available.

Ms McCaughey—The study related to salmonella and not all of those cases of salmonellawould be caused by food-borne illness.

Senator FORSHAW—They also estimated the cost to the community was around $2 billionper annum. Is that an accurate figure? That is based upon your data.

Dr Burch —Again, these are very broad based estimates, sometimes on the projections ofother countries.

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Senator FORSHAW—I was just checking to see whether they actually quoted your dataaccurately.

Dr Burch —We have quoted those same sources and others have quoted the same sources.Senator FORSHAW—That is all I have for ANZFA. I do thank you for your patience and

indulgence in going through what was probably some fairly pedestrian issues.CHAIR —There being no further questions for ANZFA, we move to subprogram 1.3.

Subprogram 1.3—Health Research and InformationSenator FORSHAW—I have a few questions following on from the questions asked on

the last occasion regarding the National Health and Medical Research Council Board. Youdid provide a list of names which sets out the members of the board by category, if I can usethat word. I am not sure whether that is terribly polite. As you acknowledge, the act providesthat persons shall be appointed from a range of disciplines or professions or qualifications aswell as state and departmental bodies.

In addition to the various members of the board who have been appointed pursuant tosubsections (a) through to (o) of the act, the act provides that ‘the Minister shall appoint nomore than two other persons with experience relevant to the functions of the council’. I didask some questions on this last time. The two persons appointed are Dr Stella Clark and MsCelia Mabel Kemp. The information you have provided says:Dr Clark is a scientific executive officer at the Baker Medical Research Institute in Melbourne. She isa science graduate who has pursued her interests in science and medical research in Australia andoverseas.

With respect to Celia Mabel Kemp, it states:Ms Kemp is a medical law student at the University of Melbourne. She attended the Presbyterian LadiesCollege in Melbourne and achieved very high results in the International Baccalaureate. She has experi-ence as a coordinator of the Asian Medical Students Society and has presented papers on medico-legalissues at the 17th Annual Asian Medical Students Conference.

Can you advise me what specific expertise Ms Kemp has which would be ‘relevant to thefunctions of the council’?

Mr Wells —As it set out in the advice provided to you, she is a medical student and shehas also had involvement in international conferences relating to medical students.

Senator FORSHAW—You consider that being a medical student means that you haveexpertise ‘relevant to the functions of the council’?

Mr Wells —The act does not specify the nature of expertise. It just says ‘relevant expertise’.Her studies are relevant to the work of the council in that they are medical studies.

Senator FORSHAW—Yes. I note that when you look at all of the other appointments—andinformation is provided about each of the other persons—it is a very impressive list ofqualifications, experience and expertise, even though it is in shorthand form. You would agreewith that of course?

Mr Wells —The other categories spelt out in the act the nature of the expertise required.The act also goes on to specify bodies from which nominations must be sought.

Senator FORSHAW—I do not know whether I concede that it spells out the nature of theexpertise required to any great extent. For instance, it says:(d) a person with expertise in health care training

It then lists the person appointed and their background. It says:a person with knowledge of professional medical standards and expertise in postgraduate medical training

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Another category is ‘a person with a background in and knowledge of the trade unionmovement’. The person appointed is Professor Duggin, who is the ‘head of the toxicology unitof the Royal Prince Alfred Hospital and Royal Alexandra Hospital for Children, Area Directorof the Division of Laboratory Medicine, the central Sydney area health service and Directorof the renal diagnostic laboratory at Royal Prince Alfred Hospital. Professor Duggin bringsclinical research, teaching and administrative expertise. He has been a member and officebearer in the Australian Salaried Medical Officers Federation for many years’—which of courseis the trade union reference. There is a wealth of experience there and similarly with all theother appointments. I am wondering if you can be any more specific about what expertise astudent, a person studying law/medicine, has which would be relevant to the functions of theboard of the National Health and Medical Research Council.

Mr Wells —I think it goes to a mix of the range of expertise on the council. Ms Kemprepresents a group, if you like, of the broader health area that is not otherwise represented onthe council—that is, the level of medical students.

Senator FORSHAW—Is that the real reason? It was decided to appoint a person torepresent medical students on the council.

Mr Wells —No. You asked me what expertise she brought to the council. That is what Isaid. I am not speculating on the reasons for her appointment.

Senator WEST—Is she doing the law or the medical part of her degree at present or whathas she done? Has she done the medical part of her degree and is now doing the law part ofher degree or hasn’t she started that?

Mr Wells —I could not comment on that. I would have to take that on notice as to whatstage of her studies she is through.

Senator FORSHAW—Would you find that out and let us know at what stage she was atthe time she was appointed, which of course was this year anyway?

Mr Wells —I will take that on notice.

Senator FORSHAW—Is there any specific expertise that would be relevant to the functionsof the board deriving from the fact that this person obtained a very high pass in theInternational Baccalaureate?

Mr Wells —I do not think there is anything specific about that, Senator, that relates to thework of the council. It talks about her level of achievement.

Senator FORSHAW—Yes, but of course I appreciate that it may be put in there to givea little bit of fill to the description. There is nothing of which I am aware that would, in anyway, suggest that the International Baccalaureate exam has a direct relevance to the work ofthe National Health and Medical Research Council or medical legal issues in any sort ofgeneral way. Can you think of any?

Mr Wells —I just take that as pointing to her level of achievement in what she has doneto date.

Senator FORSHAW—But not specifically in areas which would be relevant to the NationalHealth and Medical Research Council. I am bearing in mind that when you look at thedescription of each of the other persons appointed to the board, one can see a directconnection—a very direct connection—with the work of the National Health and MedicalResearch Council. For instance, Dame Margaret Guilfoyle has been appointed as a person withknowledge of the needs of users of social welfare services—a person who has been involved

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in the sector for many years, was a former government minister and continues to be involvedas a board member in a variety of organisations, a number of which are associated withmedicine. I am still waiting for an answer, if I can get one, on how the InternationalBaccalaureate sits beside all of that.

CHAIR —I think the officers have actually answered your question twice. Mr Wells hascertainly answered your question twice, Senator Forshaw. I do not know whether he hasanything further to add if he has already answered the question.

Senator FORSHAW—Do you have anything further?

Mr Wells —I could not add anything further, Senator. I am not sure what subjects she mighthave studied in that baccalaureate and I could certainly take that on notice as well. Generally,as I said earlier, I would take that to indicate a level of achievement in what she has done todate.

Senator FORSHAW—I suppose the test here is relevance to the work of the NationalHealth and Medical Research Council. I am not in any way decrying the achievement ingetting a very high pass in that exam. What I suppose I am more interested in is whether thatsays anything about the criteria used to assess the suitability of a person who is an applicantfor appointment to the board as distinct from what other qualifications or achievements theymay have. They may have been a world champion marathon runner, but so what?

Ms Murnane—The context of this is one member of the council. We are talking about ayoung person who has an established record of academic excellence, who is studying subjectsthat are relevant and bringing that perspective onto the council—something that the ministeris able to do under the particular provision of the act that he used here.

Senator FORSHAW—I will not take much longer on this. Can you tell me whatrelevance—and I think I can anticipate your answer, but I will ask the question anyway—beingthe coordinator of the Asian Medical Students Society would have to the work of theAustralian National Health and Medical Research Council?

Ms Murnane—I would say that the relevance of that and the other things you have quotedis that this is a person who is active in the community at a number of levels as well as beinginvolved in studies that are themselves relevant. She is somebody who is clearly activelyinvolved and the minister believed that the perspective she could bring to the council wouldbe one that was valuable.

Senator FORSHAW—That really does not answer the question. I have asked whether, withthe work and her position as the coordinator of the Asian Medical Students Society, you canpoint to anything beyond involvement in the community, which many hundreds of thousandsof people have, and if there is anything specific there that has a direct relevance to thefunctions of the board of the National Health and Medical Research Council.

CHAIR —Ms Murnane and Mr Wells have already said a number of times that that is acomponent of the qualifications of the person to serve on the council. Senator, I do not knowexactly what you are asking in addition to what Ms Murnane and Mr Wells have already statedand restated. Could you clarify exactly what, in addition, without repeating your question yetagain, you are seeking from them, because they have answered the question as clearly aspossible.

Senator FORSHAW—I am sure the witnesses at the table are capable of answering thequestion or indicating to me that they have nothing further to add to what they have alreadysaid.

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CHAIR —Do you have anything further to add?Senator FORSHAW—Let us not start another discussion or argument after lunch.CHAIR —I am simply asking—Senator FORSHAW—I would hazard a guess—CHAIR —Do you have anything further to add?Senator FORSHAW—Yes. I am responding to your interjection before the witness has even

had a chance to answer the question. I would hazard a guess—CHAIR —For the tenth time.Senator FORSHAW—there is not a person in this room that does not really understand

my question. The question specifically is: is there something specific about the role of theAsian Medical Students Society that has a relevance to the functions of the board of theNational Health and Medical Research Council? That is the question and that is a pretty clearquestion. I am sure the witnesses are able to answer it.

Ms Murnane—What I would say again is that the sorts of attributes and qualifications wehave talked about in relation to this person show that she is somebody who is active in hersociety at a number of levels, as well as having so far established an excellent academic trackrecord. You ask whether there might be other people who have these attributes and, of course,there might but that could be the case in relation to any committee or any appointment on anyboard.

Senator FORSHAW—I do not think I actually asked that question.Ms Murnane—I think you did.CHAIR —You implied that.Senator FORSHAW—I actually said that there were but the point I am getting at is that

the test is relevance to the functions of the board. That is the test. Notwithstanding the generalnature of the appointment that can be made under this head compared to the others, this isstill a specific requirement that there has to be expertise relevant to the functions of the boardof the NHMRC.

When you look at each of the other categories you can draw a very direct link between theexpertise, the qualifications, the work they perform and the functions of the board. What I amlooking for here is the link between the qualifications and expertise in these areas and thefunctions of the board. That is what I am asking.

CHAIR —I will ask Ms Murnane and Mr Wells for the final time: do you have anythingfurther to add to what you have already given in terms of your answers?

Mr Wells —No, I have nothing further to add.Senator FORSHAW—So you are not able to answer that question.CHAIR —The officers have answered the question. I just asked for a point of clarification—Senator FORSHAW—You are not entitled to put words in the mouths of the witnesses.CHAIR —This committee, Senator Forshaw, excuse me, is not here to suffer your temper

tantrums day in and day out.Senator FORSHAW—A bit sensitive, are we, Chair, about this issue?CHAIR —No, I am not sensitive at all.Senator FORSHAW—I think we may be.

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CHAIR —I am not sensitive at all. It has gone on for 20 minutes. If you want to conductyour temper tantrums I would hope that you would actually go out in the playground and doit because we are tired of your temper tantrums. The officers have answered your repeatedquestions. I simply ask you to move on and control your bad temper. Can I ask you to moveon and if you have no further questions on that subject—

Senator FORSHAW—I do have further questions.

CHAIR —Let’s move on to the further questions, Senator Forshaw.

Senator FORSHAW—You do not have anything further to add to the answers that you justgave me in regard to those questions. Is that the position?

Mr Wells —That is right, Senator.

Senator FORSHAW—Can you tell me whether consideration was given to other personsbeing appointed under this provision? In particular, were there any other candidates orapplicants—without naming them—who had specific qualifications, expertise and experiencein medical legal issues, such as an academic, a practitioner or a specialist in legal medicalissues? Can you tell me whether any consideration was given to any other candidates who fitinto that category?

Mr Wells —I am unaware of what consideration was given to other names. The two namesunder that category are not names where we call for nominations from outside bodies and,in those categories, they were the only names that were forwarded from the department to theminister.

Senator FORSHAW—So these were the only two names that were provided to the ministerin this category?

Mr Wells —No names were provided to the minister in this category.

Senator FORSHAW—So it was the minister’s decision, and you put forward names—orapplicants—for all the other categories but not for this one?

Mr Wells —For the categories where the act specifies that nominations are called for, wecollate those nominations and put the nominated names to the minister by category, but insection P there are no nominations sought and we did not provide any names.

Senator FORSHAW—Can you tell me who the previous members of the board were whofilled these two positions prior to these appointments and what their expertise was?

Mr Wells —Can I take that on notice?

Senator FORSHAW—Yes, certainly. Obviously, I am looking for the names and descriptionof what expertise they would have had. Finally, it also states in the comments regarding MsKemp that she has presented papers on medico legal issues at the 17th Annual Asian MedicalStudents Conference. Can you tell me where that conference was and when it was? Do youhave copies of the papers that she presented?

Mr Wells —I will take that on notice.

Senator FORSHAW—Yes, take that on notice and, if you have copies of the papers, wouldyou please provide them?

Mr Wells —I will do that, Senator.

Senator FORSHAW—Thank you. I appreciate the pleasant way in which you haveanswered the questions.

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Senator GIBBS—I have some questions on chronic fatigue syndrome. Mr Wells, at the lastestimates in June, I was asking questions about chronic fatigue syndrome and one of theanswers given was that a working party of five or six doctors from the Royal AustralianCollege of Physicians were going to look into an appropriate way to diagnose, treat and dealwith people with these symptoms of chronic fatigue. I was told that they would be publishingtheir findings in theMedical Journal of Australialater this year or in the second half of thisyear. Is it too early yet? Do you know what they have completed?

Mr Wells —My understanding is that the timetable is now that they are going to developa draft paper—an exposure draft—for circulation and comment and that now looks like it willbe available towards the end of this year. That is being done under the auspices of the Collegeof Physicians.

Senator GIBBS—I am told that there was a special ministerial inquiry into chronic fatiguesyndrome and that this inquiry recommended research funding outside the normal competitiveresearch grant system to practitioners to validate emerging treatments in CFS. Is this correct?

Mr Wells —I am unaware of any separate inquiry.

Ms Batman—I have some memory of it, but it was quite some years ago, I think, whenformer Senator Richardson was the minister.

Senator GIBBS—Really?

Ms Batman—It was an inquiry based around a particular provider that had come under thescrutiny of the Health Insurance Commission.

Senator GIBBS—That would have been what—about 3½ years ago?

Ms Batman—It could have been.

Senator GIBBS—And nothing has been done since?

Ms Batman—No. The funding for the Royal Australian College of Physicians emerged fromthat inquiry.

Senator GIBBS—Thank you very much. The rest of my questions are on Medicare.

CHAIR —As there are no further questions on 1.3, we will move on to program 2.

[2.36 p.m.]

Program 2—Health care and accessSubprogram 2.1—Medical Benefits and General Practice

CHAIR —Are there any questions?

Senator GIBBS—Ms Batman, my questions are regarding Medicare and chronic fatiguesyndrome. I have been told that practitioners with emerging treatment in CFS have been toldthat their treatments are not yet generally accepted and therefore are not payable underMedicare or that it is inappropriate to itemise them under Medicare. Is this correct?

Ms Batman—I am not aware of any of these circumstances. The Health InsuranceCommission may have told some providers this. I am not sure if Mr Watzlaff knows. Therehas been no policy ruling on any particular procedures that I know of.

Senator GIBBS—If they were told this, would it come from the HIC?

Ms Batman—There could be policy advice, which is what the department does, or if it isan interpretation of an item in relation to an assessment of a claim it could be the Health

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Insurance Commission. If it is an issue about appropriate or inappropriate practice, it couldalso be the Health Insurance Commission.

Senator GIBBS—But there is no policy on this, so how can they be advised if there is nopolicy?

Ms Batman—If depends whether there is a claim for an item that may not be on theschedule. I am not aware of the circumstances that you are talking about, but there are medicaltreatments and things that are not covered by an item on the schedule. If somebody puts ina claim for one of those items, they will be advised by a claims assessor at the HealthInsurance Commission that it is not covered by Medicare. People bring in claims forphysiotherapy or psychologist visits—a range of things that are not covered—and they willbe informed that they are not covered. It may be an item that is not on the schedule or it maybe a misitemisation of something that is on the schedule. If you have some specificcircumstances, that would be helpful.

Senator GIBBS—If it is not on the items for Medicare, could they claim it on their privatehealth insurance?

Ms Batman—It depends on their health insurer and what sort of policy they have, but itis possible. Quite a lot of things that Medicare does not cover—for example, dental andphysiotherapy—are covered by private health insurance arrangements.

Senator GIBBS—I realise that. But do you know whether Medicare covers people who aretreated with CFS and billed for it by their doctor? Are there any sort of items for CFS?

Ms Batman—If they have a consultation with a GP or a specialist and the reason is CFS,it is covered by Medicare. There is an issue around ordering pathology tests. In particular thisis one of the issues for the working party that the College of Physicians is setting up. Thereis not general agreement about what pathology tests are required for diagnosis and forcontinuing management.

But I am not particularly aware of any cases specifically about pathology tests. Certainlythere are some providers who have been counselled and who have been through theprofessional services review scheme who have ordered large amounts of pathology whencompared with other general practitioners and things. I am just not sure whether that is relatedto CFS.

Senator GIBBS—I have been advised—and if this is not true, I will stand corrected—thatpractitioners have been prosecuted already for itemising treatments. Do you know of this?

Mr Watzlaff —In terms of the question raised, as has been mentioned, there could be mattersof inappropriate practice that could be the subject of counselling by medical advisers. But thatwould not lead to any prosecution action of a criminal kind. When you mention the matterof prosecutions, that suggests we are prosecuting providers for making false claims. I am notaware of any such matter being undertaken by us at all. So I would need further detail as tothe nature of the issue that has been raised with us and our response. Could you give us moredetail as to that?

Senator GIBBS—I can. I have not got it with me down here, but I can certainly send itto you, yes. They are all the questions I have. My other questions relate to what will comeout of the royal college inquiry. Thank you.

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[2.36 p.m.]

Program 2—Health Care and AccessSubprogram 2.1—Medical Benefits and General Practice

Senator WEST—My question relates to an answer that was given to Senator Forshaw inresponse to question No. 366. We asked for an indication of the electorates from which repre-sentations had been made by members of parliament, and you have provided that. Theserepresentations related to the closure of the 84 Medicare offices. But I am just not sure in myown mind whether it is the location of the Medicare offices that is being complained or writtenabout, or whether it just relates to lower house members of parliament and is the number ofrepresentations they have made.

You might like to take this question on notice: if that is just the number of lower houserepresentations, I am interested to know how many senators also made representations, andabout what offices in which electorates. I suspect that that is possibly what you have there,but I just would like you to clarify that for me, please. It is the answer to question 366.

Ms Wood—Yes, I have it here.

Senator WEST—In answer to question on notice 371, it was stated that ‘there was no finallist created by the HIC which identified 84 specific branch offices for closure’. But on page129 of the estimates last time, Mr Evered certainly referred to the original list of 84 and theold list of 84. That is the list I am wanting to get hold of, please. What happened betweenthen and whenever the response was given?

I know that the original list of 84 was an indication of where offices would have to closeto achieve the sorts of savings we were contemplating at the time. But I want to know whatthat original list of 84 was, because you then said—after Senator Forshaw had asked a furtherquestion—‘We can very easily advise you of that.’

Mr Evered—We were still looking for a list as late as yesterday, but we have it now. AsI indicated, it was an indicative list and it was something that was consigned to history. Wecan give you the list now.

Senator WEST—I am more than happy to receive the indicative list. That would be veryhelpful. We now can have that?

Mr Evered—Yes.

Senator WEST—Thank you. I am also interested in indicative dates of closures for the 43—

Ms Wood—I could table that now.

Senator WEST—Thank you very much. On that, do you also have the accompanying datesthat indicate when the start of the education campaigns in the community will take place?

Ms Wood—The information to the public will commence between four and six weeks priorto the closure date of each branch. It may be slightly shorter than that in particular instances.But the list of branches to close was announced in May and has been widely reported. Thestaff were certainly aware that their branches were closing in May, and quite a number ofregular customers to those branches have had discussions with them. But the formal notices,the leaflets and the posters will go up somewhere between four and six weeks prior to theclosure.

Senator WEST—The advertising campaign will involve brochures in the offices, letters toGPs in the area—

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Ms Wood—No. It is a display of posters in the branch offices and an information flier forthe branch office customers. Those fliers will direct customers to the nearest Medicare officeand advise them of the alternative claiming mechanisms.

Senator WEST—So you will not be sending letters to GPs in the area?Ms Wood—No.Senator WEST—You will not be running radio ads?Ms Wood—No.Senator WEST—But you did run radio ads for the Queensland trial?Ms Wood—That was on the claiming facilities in pharmacies. I am sorry, I thought you

were talking about branch office closures. I beg your pardon.Senator WEST—I am sorry, I am getting myself confused here; I am getting ahead of

myself. Will there be any newspaper advertising for this or not?Ms Wood—None is planned at the moment. Because some of these offices do not have high

face-to-face traffic anyway, and regular customers form some of their traffic, the flier to thecustomers was seen as better satisfying their needs.

Senator WEST—Do we know what the total cost of this campaign to advise will be? Couldwe have a breakdown, please?

Ms Wood—To date, we have spent $65,931 on the closing of the branches. That is inclusivefrom May when we put out the kit and the announcement was first made, the design andprinting of the brochures and the journalists’ involvement to date. There will be some printingcosts—probably a bit more, but not a lot more.

Senator WEST—So that was?Ms Wood—That was $65,931.Senator WEST—Would it be possible to have a breakdown of how that is made up in the

various areas, please?Ms Wood—Yes.Senator WEST—I am happy for you to put that on notice, if you like.Ms Wood—Yes.Senator WEST—Who is undertaking the campaign? Is it the HIC, or have you outsourced

some of the work?Ms Wood—We took some public relations advice from Burston Marsteller, and the payment

for that was $10,309.Senator WEST—How were they chosen?Ms Wood—As a result of a tender and then interviewing, and they had made presentations

to do a range of PR work for the HIC.Senator WEST—This was done through OGIA, the Office of Government Information and

Advertising?Ms Wood—No.Senator WEST—It was not? It was done just by the HIC?Ms Wood—Yes.Senator WEST—Is that a normal way for the HIC to do its advertising and tendering?

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Ms Wood—To this date, to my knowledge, yes.

Senator WEST—Is that because you are an independent authority?

Ms Wood—Yes.

Senator WEST—How is the Easyclaim system going?

Ms Wood—The roll-out of the 103 pharmacies is starting today in Oberon; it is the firstof the roll-outs.

Senator WEST—I hope the weather is like this and not like Oberon weather can be.

Ms Wood—Yes. The five pharmacies involved in the pilot in Queensland have all askedto be part of the ongoing program—all five of them. I think that signifies that they saw thisas being of benefit to their business. The first of the roll-out is happening in Oberon today,as I have said. Then we are waiting a week before we start with the next one, because the pilotidentified many issues regarding notice on how to use it, the comments from the pharmacists,et cetera. As a result of the feedback we got, what we are rolling out is quite a bit differentfrom what we originally put in with the pilot.

Senator WEST—What are you going to give Bob Bearup’s pharmacy in Oberon?

Ms Wood—The fax machine, the booth and the advertising, et cetera. That has been setup as a result of the pilot.

Senator WEST—Will they all be getting the fax machine; or will some be getting electronickiosks, and that sort of thing?

Ms Wood—No. All 103 pharmacies will be getting the fax machine. They were given thechoice of a booth or a desk. The majority of them chose the booth, rather than the desk. Itjust depends. What each pharmacy is getting is whichever combination of desk and fax orbooth and fax they requested. The set-up of the booth is identical for every pharmacist; theset-up of the desk is identical. The advertising is identical for both on how to use the faxmachine and how to use the free phone line, and all the rest of it. So it is a standard kit thatwill be put in those 103 pharmacies around Australia. It is expected that the roll out will becompleted by mid-October.

Senator WEST—When will you be reviewing and assessing that?

Ms Wood—We intend to review it over the next six months. That gives the community thechance to use it, to have a look at it and to see what they think about it and provide thefeedback. The company—and I cannot remember their name; I will take that on notice—thatdid the survey for the pilot is also doing this further one. That company will go back to thosepilot sites again to see how it is going when it is reinstalled in those pilot sites.

Senator WEST—When does Forbes get the roll-out?

Ms Wood—I have a schedule here. It shows that 1 September is the date scheduled forForbes and West Wyalong.

Senator WEST—So obviously there are more than two people installing this.

Ms Wood—Yes. In each state we have teams. The company that is looking after the supplyof the fax—that is Inchcape NRG, the company that got the tender—is also looking after itsinstallation and the support services.

Senator WEST—I would appreciate it if you could give me some idea of the proposed rollout timetable, please. That would be helpful.

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Ms Wood—I will not table it here; I will just confirm it. We are also planning the pilot ofthe electronic kiosk. Work has been proceeding on that. We are into our final planning forthe pilot of the interactive kiosk, and we hope to be able to pilot it at about the end ofSeptember.

Senator WEST—How many kiosk pilots are you planning to run?Ms Wood—That is not yet finalised. We are getting close to deciding where we will run

those and how many we will put in. But, as I say, that is not yet finalised.Senator WEST—What sort of physical location would you be looking to put them in?Ms Wood—Just a pharmacy. It still will be in rural areas because it is part of the rural and

remote policy. But we have not yet finalised that. We do not want to be too far away fromcapital cities because of its technology being more sophisticated.

Senator WEST—So you have 103 on the pilot for the pharmacies, all of whom—with theexception of Forbes—are supposed to be in receipt of the isolated pharmacy allowance, or theremote and rural pharmacy allowance. We are now about to embark upon the kiosks.

Ms Wood—A pilot of the kiosk, yes.Senator WEST—How many are in the pilot?Ms Wood—We do not know yet.Senator WEST—Are we looking at five, 55, 105 or 205?Ms Wood—Probably less than five and more than two.Senator WEST—For how long do you intend to run that pilot?Ms Wood—Again for six months because, once again, it does take a time. What the pilot

of the fax showed us was that the six-months gave us lots more information. We got a rushof information early, and then bits more came trickling through as people got used to it andsaid, ‘Well, what about this; what about that?’

Senator WEST—When will you be making a decision on the pilot of the kiosk?Ms Wood—I hope by the end of August.Senator WEST—In two weeks time?Ms Wood—Yes. As I said, we are in towards our final planning.Senator WEST—Is it possible to take on notice and, in two weeks time when you have

made the decisions, give me an answer as to the location of, the number involved in, and thelength of time planned for the undertaking of, the pilot? When do you expect that pilot to beevaluated?

Also, do you expect to roll out more kiosks after you have completed the evaluation or—asyou have done with the other ones, in fact—sort of almost coincidentally at the same time?They are the sorts of answers I am interested in knowing. Also, I am interested in knowingwhat the thoughts are or the thinking is in terms of the number of places that you think youcan roll a kiosk out into.

Ms Wood—We will not be in a position to answer that until we have seen the things fromthe pilot like the cost, the public acceptance, the technical feasibility, the fraud risks and theother things that we look at in the pilot. Some of those will become evident fairly quickly,and then we will be in a better position to answer those questions, but we could certainlyprovide you—I would say by the end of August—with details of where the pilot sites are goingto be for the kiosk.

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Senator WEST—I am interested in the sorts of places in which you might be going to runthese. For instance, you would not put a kiosk in a Medicare agency, would you?

Ms Wood—No. These would be well away from Medicare offices and well away from thesefaxes that we are installing so we are looking to keep it separate.

Senator WEST—What criteria are you going to use to install the kiosks?Ms Wood—That is what we are working on.Senator WEST—You have said that you would not want it too far away from the capital

cities because it involves more complicated and more sophisticated technology. I am justwondering if I should make an assumption that the Lithgow Medicare office is still okay; itprobably is because Oberon is not all that far away either.

Ms Wood—No.Mr Evered—I think the point about not running it too far away from capital cities is why

we are running the pilot. It is a pilot thing; after that one would assume that it could be asfar away as any other piece of technology.

Senator WEST—Broken Hill? I don’t want the Medicare office in Broken Hill to close.Ms Wood—Oh!Senator WEST—Sorry, Ms Wood, I should not do that to you. That was naughty of me.

I apologise because people might read theHansard, just see that little bit and take it out ofcontext. I do not want to start any rumours.

Ms Wood—No.Senator WEST—I apologise for that flippant remark on my part. I will stop generally

thinking aloud on this issue. If you can provide us with as much detail as you can on notice,I will appreciate that. I realise that it will be a couple of weeks in coming because it has notbeen decided yet, and roll on November. I will pursue that further in November. In relationto Easyclaim and the advertising promotional material, $61,991 was spent just on the pilot.Is that correct?

Ms Wood—That is correct.Senator WEST—Of that, $26,540 went in brochure production, but that does not include

brochure printing. That seems an awful lot of money for brochure production given thebrochure is a lot of writing and there is not much in the way of pix—if I am illiterate, I amgoing to have a problem, and just for good measure you throw in an immunisation message.I accept that this artwork will be used in the device roll-out.

Ms Wood—The printing was $4,594.Senator WEST—For how many brochures?Ms Wood—I have to take that on notice. I am not sure.Senator WEST—One assumes that for a couple of thousand brochures there has been about

$31,000 spent to date just on brochure production and printing. Of that, less than $4,500 isbrochure production.

Ms Wood—The artwork will be used in the device roll-out brochures as well.

Senator WEST—Yes, I realise that.

Ms Wood—So it would be part of the set-up costs as well for the printing.Senator WEST—Who did the artwork?

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Ms Wood—I will take that on notice.

Senator WEST—And also the method that was undertaken to put out the tender andeverything like that because I would like a break-down of those costs. We see that $17,105was spent on research. What was the research? Was this in relation to the evaluation of theprocess?

Ms Wood—Yes, the satisfaction one. I think we provided you with the reports. That wasthe company that did that research.

Senator WEST—So does this $62,000-odd include the cost of the evaluation?

Ms Wood—Yes, that is that research.

Senator WEST—So the $62,000 was more than advertising and promotional expenditure;it was in fact advertising, promotional and evaluation. Or is there additional evaluationexpenditure elsewhere?

Ms Wood—No, that was the research up to the report of that evaluation.

Senator WEST—That answers a question that I was not sure about. I think that is all I haveon Easyclaim and the Medicare offices.

Senator FORSHAW—I have a number of questions with respect to the location of Medicareoffices. We did ask for information on the last occasion and it was provided, but I have somefurther questions which I am happy to put on notice because you will need to provide specificdetails on quite a number of offices.

Ms Wood—Okay.

Senator FORSHAW—Thank you very much.

CHAIR —Are there any further questions on 2.1?

Senator WEST—Yes. In question 432, I asked, now we are six months into the RACGPtraining program, how many of the top echelon of those in the academic stream had chosenrural locations within the program? The answer was that the department had formally contactedthe RACGP to obtain this information pertaining to RACGP registrars who choose rurallocations and a written response was expected within two weeks. Has that come? If not, mayI place it back on notice?

Ms Rogers—We will take that on notice and follow up for you.

Senator WEST—Thank you. As I say, I am still interested to know the number of top-flightacademic students who choose to go into general practice rather than to be a professorialstudent in a surgical, medical or one of those areas that are often considered sexy. I am happyfor you to leave that one on notice.

Before we move on to subprogram 2.2, there is something I want to request in 2.1. ProfessorLouise Bryson from the University of Newcastle gave a presentation at the Rural 2000Conference in Wagga, which ran from 2 to 4 July. It was a statement in relation to womenin country areas refusing to seek medical attention for various reasons. One of these was theydid not feel comfortable consulting male doctors. Is it possible for you to get me a copy ofthe research that she might have done?

Ms Rogers—We will see what we can do to follow that up for you.

Senator WEST—Thank you. If you have not seen it, and I have not got a copy of it, itmight be of interest to you people too.

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Subprogram 2.2—Pharmaceutical benefits

Senator FORSHAW—On the last occasion, I asked a question which was taken on notice.The question was: who was intended to be consulted in relation to the PBAC’s considerationof the therapeutic drug groups?

An answer was provided in writing which stated that the PBAC membership includes aprofessor of clinical pharmacology, a clinical pharmacologist with experience in gastroenterol-ogy, a specialist cardiologist and a professor of psychiatry. I will not ask for their exam results!The answer went on to say that, as the six drug groups related to the areas of cardiology,psychiatry and gastroenterology had been previously considered through an evidence basedprocess, the PBAC did not feel that further clinical input was necessary. It also said that thePBAC asked for the views of the Australian Pharmaceutical Manufacturers Association, andthat various groups covering consumers, health professionals and industry will be asked toprovide input into the information campaign to support therapeutic group premiums. That isthe end of the answer.

What was the precise process of seeking the views of the Australian PharmaceuticalManufacturers Association? When did it occur? Were meetings held? Was there a responsein writing? What occurred?

Mr Stevens—The process mainly involved seeking advice from the Pharmaceutical BenefitsAdvisory Committee, which is the government’s expert on pharmaceutical matters. Thereference to the Australian Pharmaceutical Manufacturers Association, APMA, was madebecause we have regular meetings with that body. The PBAC, the department and the APMAhave regular meetings. At one of those meetings, which occurred immediately prior to thePBAC looking at the therapeutic groups, there was a general discussion with the APMAexecutive on that issue. Specific issues about specific drugs were not discussed.

Senator FORSHAW—When was that meeting?

Mr Stevens—The meeting, from memory, was either 3 or 4 June.

Senator FORSHAW—June?

Mr Stevens—Yes.

Senator FORSHAW—This year?

Mr Stevens—This year.

Senator FORSHAW—That is, after the budget announcement?

Mr Stevens—Yes.

Senator FORSHAW—So there was no discussion with the APMA prior to the budgetannouncement?

Mr Stevens—No.

Senator FORSHAW—What was the purpose of the discussion on 4 June at one of these‘regular’ meetings that you just referred to?

Mr Stevens—The meeting held on 4 June was a regular scheduled meeting held betweenthe APMA and the PBAC, and representatives of the department were there. There was quitea range of issues discussed, mostly of a general procedural nature. One of those topicsdiscussed was how we were going to process the new policy announced in the budget fortherapeutic group premiums.

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Senator FORSHAW—What was the reason for not discussing the matter with the PBACprior to the budget? I assume it was because it was a budget announcement and they have tobe kept in the dark about it. Was that the position?

Mr Stevens—I could not elaborate on that any further.Senator FORSHAW—Thank you. I got one right at least. Other than that meeting on 4

June—which was a couple of days after our estimates meeting, because the estimates tookplace on 2 June and, I think, 4 June as well—have there been any other discussions,consultations or official communications between yourselves and the association?

Mr Stevens—There have been letters written to individual members of the industry—individual pharmaceutical companies—asking them to supply certain details about their drugswhich may be subject to the therapeutic group premiums. As per the norm, we have regulardiscussions with companies. We operate very much an open-door policy in the department,so if a company wishes to raise a particular issue with us we are there to discuss it. Thosediscussions would include therapeutic group premiums, on occasion, as well as covering arange of other issues mainly specific to individual companies about their individual drugs.There has not been a general meeting between the industry and the government on the issue.

Senator FORSHAW—Are you able to be a bit more specific about what was discussedat that meeting on 4 June? I know that you said the matter was amongst a range of issues andthat it was at one of the regular meetings. Can you be any more specific as to what discussiontook place, what arrangements were made or what proposals were put in regard to thismeasure?

Mr Stevens—The main purpose of the discussions concerned procedural matters. There wasa record of that meeting that took place, and if you wish I can get you a copy of that.

Senator FORSHAW—I would like a copy of that, thank you, if you can provide it. Thewritten answer to your question—and I think I am interpreting this correctly, but you mightcorrect me if I am wrong—says that the PBAC asked the views of the AustralianPharmaceutical Manufacturers Association. That says to me a bit more than that this matterwas just discussed at one of the regular meetings, because the question that was asked wasabout what consultations were intended to take place regarding this measure. When it saysthat you asked for the views, was that a formal request for the manufacturers association toput particular views to you on this measure in general or on specific matters?

Mr Stevens—The matter did not come from the department. It came from the PBAC.Senator FORSHAW—Okay.Mr Stevens—It was a letter from the chairman of the PBAC to the APMA advising them

of the situation and suggesting that it be put on the agenda for that meeting.Senator FORSHAW—For that meeting?Mr Stevens—Yes.Senator FORSHAW—Could you provide us with a copy of that letter?Mr Stevens—I do not have any problem with that. That is a PBAC letter; I would have to

clear it through the PBAC of course.Senator FORSHAW—Yes. What views were put to the PBAC or to yourselves in regard

to this issue?Mr Stevens—In answer to that, the easiest way is to provide you with a copy of the minutes

of what took place at that meeting.

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Senator FORSHAW—Outside of the minutes of the meeting and up until the present day,has there been no other official communication in writing from the government or the PBACto APMA and vice versa?

Mr Stevens—Not that I am aware of.Senator FORSHAW—Would you check that and confirm that is the situation?Mr Stevens—I will check that.Senator FORSHAW—I should put to you—and I admit this is hearsay, so you can draw

that to my attention, but I am already aware of it—that the Pharmaceutical ManufacturersAssociation would say that really there has been no consultation at all about this issue withthe government. By consultation, I mean meaningful discussions—consultation about theimplementation of this measure, the effectiveness of it and so on. Admittedly I am putting toyou that that is what they have conveyed to me, but how would you respond to that?

Mr Stevens—Before the budget, naturally there was no consultation with people outsidethe government. After the budget announcement, PBAC, as we have already indicated, wroteto the APMA about the issue. The matter has been discussed by the Pharmaceutical BenefitsPricing Authority, of which a representative of the APMA is a member. After that meetingthere a timetable was circulated to affected pharmaceutical companies of what was to proceedafter that as well as a request for them to provide certain data to us. There was also, prior tothe pricing authority meeting, a seminar held in Sydney to which pharmaceutical companieswere invited. One of the agenda items was this particular topic.

Senator FORSHAW—Would you provide copies of that documentation that you justreferred to a moment ago from the pricing authority to the companies? I think you said thatit included a time line or a timetable of what is to happen.

Mr Stevens—I presume you want a sample copy of one of the letters. You would not wantthem all.

Senator FORSHAW—I assume they are all the same.Mr Stevens—Except for the drug names, that is all.Senator FORSHAW—You pre-empted my next question. Why did you say ‘except for the

drug names’?Mr Stevens—The drug names change between companies. We only write to each individual

company about their own specific drugs.Senator FORSHAW—I thought you were referring to something else. Have you provided

to the companies or to the association the actual groupings?Mr Stevens—No.Senator FORSHAW—Do you intend to?Mr Stevens—At this stage no, because those groupings have not been finalised.Senator FORSHAW—Let us assume for a moment that PBAC or the department in some

form or other should be undertaking this task. Are you going to consult with the companiesin any detail about the make-up of the groupings, the particular brand product that is goingto be used as the base price? Are you going to consult in detail about what these various grouppremiums are going to look like?

Mr Stevens—That still has to be worked out. That work is being carried out at present.Once the decision has been made by the pricing authority, the drug and the price should form

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the benchmark. The companies will then be informed of those and asked what they wish todo about the pricing of their own individual products.

Senator FORSHAW—So there is no process whereby the companies will be able to sitdown earlier than that and actually work through and discuss with you the appropriatenessof the way in which the groups are structured and the way in which the price is set and soon.

Mr Stevens—In regard to the way in which the price is set, the companies are aware of thatprocess. That was the purpose of the seminar before the last pricing authority meeting. It isa process that has been in place for many years that the pricing authority uses. The actual druggroupings are a matter for government decision, and in that respect they have received advicefrom the PBAC.

Senator FORSHAW—I am asking this question because the issue involved here, at leastfrom the view of the companies and from the profession and others, is that of the actualappropriateness of the groupings. In a number of cases the drugs are not strictly like for likewithin a group. There may be differences. That is very much at the nub of some of theopposition to this measure. For particular patients a brand of drug within a group is betteraccording to their medical practitioner than another brand, and they are not purely like for likebut rather there are particular differences and different effects.

What is at issue here is a matter that certainly concerns manufacturers, amongst a range ofothers. It concerns the profession; it concerns a lot of people. These issues should be addressedbefore the system is implemented, if it is ultimately implemented in the way that it has beendecided, which is 1 July 1998.

It has been certainly expressed to me that this is going to be presented to the companies asa fait accompli. One then assumes that some significant difficulties may arise and people mayfind that they either have to pay a substantially higher price for the drug subscribed by theirdoctor or they have to go on to another brand of drug. This drug may be within the groupbecause of cost reasons but it may not be the appropriate drug according to that person’smedical practitioner and may cause problems. I have made a statement instead of asking aquestion. That is why they are asking for the opportunity to consult and discuss with you. Isthat process able to occur or not?

Mr Stevens—The matter of the actual drugs in a group, as I mentioned before, is a matterfor government decision. The advice that you receive on that regard is from the PBAC, theexperts in that field. The PBAC has a fair amount of information that is available to it. Mainlythat would have been put to it by the drug companies when they were listing the drugs.

Senator FORSHAW—Who was responsible for this proposal? Was it something that wasput forward by the PBAC to the department, or was it something that the PBAC was askedto look at and come back with a proposal on? Are you able to tell me that? Who initiated thedevelopment of this proposal?

Mr Stevens—It was a decision by government to the Budget. PBAC was asked for advice.

Senator FORSHAW—That is what I thought. I am sure Senator West has some furtherquestions.

Senator WEST—It is normal for PBAC, where you have specialist areas, to conscript orco-opt on for those particular areas people with specialist expertise in that particular diseasegrouping or the like. Has PBAC done that in relation to the therapeutic grouping?

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Mr Stevens—There is a facility available for PBAC to consult with specialist bodies. Thedecision as to whether they do it or not is a matter for PBAC. It is not a compulsion that theydo that.

Senator WEST—Can you take on notice and advise me where PBAC has consulted withthe appropriate speciality units that deal with all of those six grouping areas? Has there beenany consultation with the endocrinologists for people who suffer from diabetes? Whatconsultation has taken place with the College of Dermatologists in relation to that sort ofthing?

I have had complaints that there has not been a great deal of consultation either before orafter, because I want to get on to specific drug groups. While we are talking about therapeuticgroup premiums, are you aware of research that has been done overseas looking at theincreased costs to other parts of the health system when states or territories or governmentsor whatever have moved to a therapeutic group premium process?

Mr Stevens—I am not aware of the specifics on that. I am aware of a press release that Ibelieve the APMA put out yesterday. They stated some figures in that. I have not seen thedetails on it. I have asked for those details to be provided.

Senator WEST—So you are not aware of the work of Paul Gross and Roger Fortescue inan article inHealth Economicsmonograph No. 70 of August this year?

Mr Stevens—I have noted that in a press release the APMA issued. I have asked the APMAto provide me with a copy.

Senator FORSHAW—I would be happy to give you one.

Senator WEST—In the precis it would appear that in the US state of New Hampshirerestrictions on the number of drug prescriptions for patients treated for schizophrenia reduceddrug volumes by 35 per cent but increased admission to nursing homes by more than 50 percent. The additional costs for hospitalisations, emergency mental health care and additionalclinic visits were roughly nine times the saving by volume from volume controls for the drugs.They list quite a number of others. I think it will be very interesting reading for people.

This brings me to a constituent who has written to me. I think you have probably seen theletter because I have forwarded it to the minister but I have not yet received a reply. It is agentleman who has arterial disease plus a cardiovascular disease plus a unipolar effectiveillness, which is one of the major depressives. He is on a pension. He is now on Cardizem,Lopid and Zocor for his cardiovascular disease. They are all on the list to go. They are beingtargeted.

He takes Cardizem because the cheaper beta blockers produce depression for him. He alreadyhas a depressive illness. In respect of Lopid and Zocor, they are essential to reduce hisextremely elevated saturated triglycerides and cholesterol levels. The medication he takes forthe depression is Surmontil and Zoloft. Surmontil is an antidepressant. It is still effective forthe side-effects associated with the disease, the loss of appetite and other unpleasant problems.

He has tried all basic groups of antidepressants. They are either ineffective or have seriousside-effects. All the drugs that he is on have been targeted for additional payments. I amconcerned with what is going to happen to these people—and there are many individuals outthere who, as any pharmacist and doctor will know, are quite capable of having anidiosyncratic reaction to any drug—on low incomes who have this sort of case history. I wouldlove someone to be able to tell me what the options for them are.

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Ms Rogers—We have an expert committee looking at all those types of issues. If you wouldlike to give us a copy of that particular—

Senator WEST—You already have it because I have made representations. I am notprepared to name him publicly here or give more details, but in the previous estimates thatis the sort of thing I raised with you. I expressed concerns about it because there are a wholelot of drugs here that are used by a lot of people. Whilst they may be dismissed for ninety-fiveper cent of people, there is a significant number of people for whom they are very effectiveand are the only drugs available for them to use.

I want to turn to some questions taken on notice during the last estimates. The answers weregiven very swiftly in late June, but I think the department was remiss in not providing me withupdated answers. In question 435 I asked whether there had been any reaction, complaints orconcerns from gynaecologists and dermatologists about antifungals. The answer was that thedepartment had not received correspondence from gynaecologists and dermatologists in relationto the deletion of topical antifungal preparations from part of the budget. It had received oneletter from the College of Dermatologists. I would suggest that you have had at least two orthree representations from me directly—or presumably the minister’s office has sent them tothe department—with dermatologists concerned about the deletion of some of the antifungalsboth topical and oral. I think that answer is incomplete and should have been completed.

I think that answer is incomplete and should have been completed. You then go on, in theanswer to question No. 437, to say:

There is no information or data available giving the prevalence of onychomycosis in the community.

I have correspondence here from an associate professor at one of the teaching hospitals inAdelaide, who included in the material he has given me an article out of theJournal of theAmerican Academy of Dermatology, Volume 33, No. 5, Part I. It is an article by Watson etal: Alan Watson, who is from the Royal Newcastle Hospital; John Marley, who is from theUniversity of Adelaide; David Ellis, who is from the Women’s and Children’s Hospital inSouth Australia; and Tony Williams, who is from the medical department of Sandoz Australia.In their opening to this particular article, they say:

Onychomycosis occurs in approximately 2.7% of the general population but increases to 10% in middle-aged elderly persons.1 About 80 % of cases occur in the toe nails.2

The first two sentences in that particular article give me an indication as to the prevalence ofthe disease in the community. They also give me an indication of the age group affected, yetyou have told me that there is no documentation of the age group typically affected. Thesource for their statement was Roberts D.T.,Prevalence of dermatophyte onychomycosis inthe United Kingdom: results of an omnibus study. Br J Dermatol 1992; 126(suppl): 39:23-7

I find your answer is also inadequate when, without a great deal of difficulty, I have beenprovided—certainly by people who would have known the issue—with information that givesme a great deal more information than I could have got from the department. It makes mewonder how much research PBAC and everybody else may well have done into this particulardisease and a few others.

Senator Herron—Senator West, nobody knows the incidence of onychomycosis. I havegot some on my fingernail if you would like to see some.

Senator WEST—No, I do not want to see some.

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Senator Herron—That is how prevalent it is. I have not seen that article, but I wouldassume that it is a study done of a particular subgroup. I would be happy to look at it. It isa UK study as well.

Senator WEST—Some of it is a UK study.

Senator Herron—I would suggest that if we were to check this room we would probablyfind about five or six people with onychomycosis.

Senator WEST—I am just saying, Minister, that I am not happy with the answer that I havebeen given. If this material has surfaced after the answer was given, I would have thought thatthe department could well have put in a supplementary answer, which they have done on otheroccasions.

We are also told that there is no evidence that HIV and AIDS patients suffer fromonychomycosis. I have a letter from a different dermatologist, who has in fact written to DrGraham, making the assertion that:It is also a serious problem in patients suffering from HIV-AIDS.

I have a bit of a problem when I am getting information from parts of the profession whichI have not been given in the department’s answer, or which are contrary to the department’sanswer. If it is a controversial issue, you only have to write, ‘It is a controversial issue andwe disagree.’ If that is the case, I would like to know why you disagree with this. I am veryfrustrated and concerned.

Ms Rogers—If you would like to give us copies of each of those articles, we wouldcertainly take that into consideration.

Senator WEST—I am more than happy to provide you with copies. I can only go by whatI am provided with. I do take it that if someone has the label of associate professor that oneis to assume they do have some knowledge in this particular area. When other letters cometo me from people who are in departments of dermatology at major teaching hospitals aroundthis country, it is a pretty fair assumption that these people do not normally get to thisparticular situation in their careers without having some knowledge of this. I know that othershave gone to—

Senator FORSHAW—The International Baccalaureate—

Senator WEST—Yes, I wonder if they have been to the International Baccalaureate. I knowthat as well as the letters sent to Dr Graham, letters were sent to Senator Ellison when he wasthe parliamentary secretary. I know because they were copied to me amongst a whole groupof other people. What is going to happen with Lamisil and the other drug that they areconcerned about—particularly Lamisil and the treatment of onychomyosis? Will it continueto be delisted?

Senator Herron—If I can respond to your question 437, the answer given there is absolutelycorrect.

Senator WEST—Fine.

Senator Herron—The question is: what is the prevalence of onychomyosis in thecommunity? It says that there is no information data available given the prevalence ofonychomyosis. It goes on to explain the supplementary questions. It is a fungal infection ofthe bed of the nail—

Senator WEST—Yes, I have read that.

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Senator Herron—That is what I am saying—that you are attacking the officers for givingyou an inadequate answer when the answer is not available; it just is not available. It is sucha common condition in general practice. There is no data about it. We do not go aroundchecking people’s fingernails and their toenails.

Senator WEST—That is fine. I will go back to the people who have written to me—

Senator FORSHAW—You are not British royalty—that is your trouble.

Senator Herron—If everybody takes their shoes off we will get Dr Eggleston to go around.That is the ridiculous nature of it.

Senator WEST—I will go back to check if their assumptions or their interpretations arethe same. That is fine. That is not a problem. I will certainly go back to them with that. ButI take it there has been no change of mind about the delisting of Lamisil?

Mr Stevens—No, there has not.

Senator WEST—Okay.

Ms Murnane—I want to make a point about the answer to the question. We do try to makethe answers up to date. We also try to make them prompt.

Senator WEST—Yes, I know, and—

Ms Murnane—After the budget estimates we had 140 that we returned as promptly as wecould.

Senator WEST—Yes, I am not being critical of that.

Ms Murnane—We will take account of the further information that you have drawn to ourattention today and provide you with an answer that takes that into account as soon as we can.

Senator WEST—Thank you, I appreciate that. Staying with feet and this drug, whatconsultation took place with Diabetes Australia or with any of the endocrinologists in relationto the decision to delist Lamisil—if any took place?

Mr Stevens—I am not aware of any consultation with Diabetes Australia. Again, it was abudgetary decision.

Senator FORSHAW—Sorry to interrupt. It is not always the case that drugs that aredelisted are only done in budgets. Isn’t that the case? The PBAC can delist drugs, and listdrugs at any time, really.

Mr Stevens—You are quite correct—a number of other delistings do occur. The mostprevalent would be due to the manufacturer asking for the drug to be withdrawn.

Senator FORSHAW—The point I want to get to is that if you consider the general positionand put aside for the moment that these measures were listed in the budget, is it the case thatno consultation occurs at all before a drug is delisted or listed? Again, put aside the questionof when the company itself seeks to have it delisted for particular reasons. Whilst this wasannounced in the budget, it is the sort of measure that may otherwise occur at any other pointof time in the year when there would not necessarily be any restriction upon the PBAC or thedepartment at least talking to a company, an organisation, a professional group or whoeverabout it before it actually implemented or announced the decision.

Mr Stevens—The decision, as I say, was a budgetary decision. It was referred to the PBACafter the budget and their advice was sought.

Senator FORSHAW—I think this was what Senator West was getting at.

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Senator WEST—So there have been no discussions with any dermatologist or anybodyabout the use of Grisiofulvin in relation to the treatment of a number of dermatologicalconditions?

Mr Stevens—I am not aware of what discussions took place. I am aware that the continuedlisting of those drugs was the subject of discussion with the PBAC over a number of years,and that there had been discussions with the companies and, I presume, with the specialistsinvolved.

Senator WEST—I have had it alleged to me that Grisiofulvin has a lot more side effectsthan Lamisil in the treatment of onychomycosis. I have also had it put to me by dermatologiststhat the clear-up rate after a three-month course of treatment for onychomycosis is somethinglike 80 or 90 per cent whereas, after an 18-month treatment course with Grisiofulvin, it isabout 20 per cent. I am in no position to refute those assertions, but these are assertions thatare made to me by dermatologists. I am in a position to expect that they are competent withintheir profession, and I am wondering whether those sorts of figures were taken into accountwhen this decision was being made.

Mr Stevens—I can only respond to that by taking it on notice, Senator.Senator WEST—Thank you, because it is worrying. There is something that really worries

me in relation to diabetes. I spent 18 years nursing and the first thing a nurse, a doctor or adietitian ever told a diabetic—the first thing that anybody involved in the care of someonewith diabetes said—was, ‘Don’t do anything to your feet. Do not even cut your toenails.Always have a podiatrist cut your toenails. You must have very good feet. Your foot care isone of the most essential things that you can undertake.’ I have seen a heck of a lot ofgangrenous toes chopped off because the people have diabetes. It is almost like a little movinggangrenous procession as first the little toe goes, then the next toe goes and the next toe goesand the great toe goes, and then half the foot goes and the whole foot goes, and then belowthe knee goes.

CHAIR —Senator West, I am sure that the officers know the progress of all of this.Senator WEST—I think it is important that people are aware that this is a very serious

issue.CHAIR —I do not think we need to tell the departmental officers how to suck eggs, to be

perfectly honest.Senator FORSHAW—How to suck toes, actually!Senator WEST—No, I am not into toes, thank you very much. A lot of these episodes of

gangrene in toes for sufferers of diabetes result from simple breaks in the skin and simpleunderlying chronic infections. Are sufferers of diabetes going to be exempted from thedelisting of this drug? If this is the drug that I have dermatologists telling me is the drug ofchoice for this particular disease and we have a diabetic who has this particular disease, isthere going to be someone looking at the possibility of delisting it for these particular patients?

Senator Herron—There has been no change in the previous government’s mechanism forthe delisting of drugs—it is the same mechanism.

Senator WEST—I am not asking about that, Minister. I am asking whether it is going tobe possible for an authorisation for this drug to be purchased more cheaply and at a subsidisedrate if persons are able, through microscopic testing and pathology testing, to be diagnosedwith onychomycosis as well as their diabetes? Is this not a way around this particular problemif this is the drug of choice for that particular disease?

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Senator Herron—As I understand it—and I would be subject to the officers informing me—there is a debate that that is the drug of choice for this disease.

Senator FORSHAW—Dr Wooldridge is on the record as saying that, with the introductionof this system—I cannot remember the words exactly but I am sure I read it in one of his pressreleases—these sorts of circumstances would be looked at so that people would not have topay more for drugs where that was the only drug that would be suitable for them to beprescribed.

Senator Herron—But there is debate—Senator FORSHAW—That is a general sort of commitment. I hope I have not

misrepresented his position. If that is the case, I think the real issue and concern here—andthis is what Senator West is getting at—is that it is fine to make these statements that we aregoing to bring in this new system, but we are going to ensure that people are notdisadvantaged. What does that really mean in specific cases, which is where the real problemis—that is people could end up paying—

Senator WEST—With their lives.Senator FORSHAW—many dollars more and, potentially, through ill health as a result of

it?Mr Stevens—Can I clear up one thing? The reference Minister Wooldridge was making

there was in relation to the therapeutic group premium policy, not in relation to delisting drugs.Senator FORSHAW—I am sorry if I have misrepresented him, but I would have thought

that if he did not say that about this issue then that would concern me even more, becauseone would think that that should be a policy that is ongoing. That is what the PBAC is allabout.

Senator WEST—I would put in a very strong plea that, where there is a clinicalpresentation and it can be diagnosed on pathological testing and the person is a sufferer ofdiabetes, either type I or type II, and particularly where they have a peripheral neuropathy orperipheral vascular disease, the very least the government can do is to investigate thepossibility of this drug being allowed for them under authorisation. Minister, if there is debatewithin the medical community, let us hear it publicly.

Can I ask that it at least be taken into consideration, because it has appeared in the—is itthe weekly or the fortnightly?—magazine that the AMA puts out, as I understand it. It is anarticle by Catriona Bonfiglioli which quotes the Australian College of Dermatologists’ secretarysaying that it is short-sighted. Speaking at the World Congress of Dermatology in Sydney, DrWong said:. . . amorolfine (‘Loceryl’) and terbinafine—

which is Lamisil—should be available on the PBS because each suited different stages of onychomycosis.

Effective treatment was particularly important in diabetics, in whom infection could lead to loss of theaffected limb.

That, I think, substantiates the reason I would like the government to look at this beingavailable under authorisation, because this is an article, as I understand it, out of an AMAjournal quoting the secretary of the Australasian College of Dermatologists. I always took thosetwo together to be a fairly reputable group and a fairly reputable authority. That is my verysimple request because diabetes is becoming more prevalent in this community and is a majorproblem.

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Senator Herron—Yes, but onychomycosis is not.Senator WEST—No, but diabetes is and when you get the two together, Minister,

particularly if it is associated with peripheral vascular disease or peripheral neuropathy—Senator Herron—It may be in particular circumstances, but diabetic neuropathy in itself

has no association with onychomycosis. Onychomycosis is a fungal infection of the skin. Therewill always be special pleadings, Senator West, for listings on the Pharmaceutical BenefitsScheme. A judgment has to be made on a clinical basis as to whether those listings arewarranted or not and the government has made a decision in relation to this particular item—

Senator WEST—And it is not going to change its decision.Senator Herron—It is under continual review, as you know. The Pharmaceutical Benefits

Advisory Committee is continually reviewing things. The government will take your adviceon notice.

Senator WEST—It is not my advice; it is my request for further investigation, particularlygiven that one of the dermatologists who has written to me has said that it is also prevalentin Aboriginal communities. We know that about diabetes incidence—

Senator Herron—It is prevalent everywhere. There will be people in this room who haveonychomyosis. That is how common it is.

Senator WEST—Yes, but most of us do not have it in combination with diabetes, peripheralneuropathy and peripheral vascular disease as well. I am simply asking that the governmenttake that into consideration. Given the number of verbal and written representations I havehad—and I have made three or four representations to the minister about this particular issue—and the concerns that have been expressed to me, it is an issue that I would really like thegovernment to look at because I think it is of major concern.

CHAIR —Senator West, I think we could move on now. You have raised the issue andcanvassed it backwards and forwards.

Senator FORSHAW—Minister, can I take up the comment you just made about the clinicaljudgment that has to be made about whether drugs are listed or not listed. That is a differentthing to delisting, I would suggest, but the tests should be just as vigorous, if not more so.Is it not the case that the PBAC is supposed to make these decisions at arms length from thegovernment?

Senator Herron—Yes, but things are continually delisted. They put a booklet out, atenormous expense, every few months which delists items based on their clinical application.

Senator FORSHAW—As I understand it, on this occasion the PBAC was put in a positionwhere it had to, in effect, make the decision, on government instruction, as to the delistingof drugs. Is that not the case?

Mr Stevens—The PBAC does not make the decision. It is a government decision to delist.Senator FORSHAW—Yes, but the process involves the PBAC acting independently as an

expert body and assessing whether a drug should be listed, delisted or retained and then itmakes a recommendation which goes to the minister. Is that not the procedure?

Mr Stevens—That is the procedure. In this particular case it was somewhat the reverse ofthat. There was a budget announcement and PBAC advice was sought.

Senator FORSHAW—That is the point that I am wishing to make. Forgive me, Chair, butthis is in response to a comment made by the minister. The situation here is not the norm forthousands of other drugs.

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Senator Herron—That occurred with the previous government. That was the point that wasmade. It occurred in relation to another drug immediately we came into government.

Senator FORSHAW—We have been down that track previously and I do not want toreopen it. The argument keeps getting put that this is merely an extension of some of thethings that we did. I think it is a bit different. In any event, Senator West has made herrequest.

Senator WEST—While we are on pharmaceutical benefits issues, I understand that therehas been some benchmarking done on diabetic test strips. Is that right? Some diabetics havegot on to me about this.

Mr Stevens—I think there is a bit of misinformation about this particular issue out therein the community. It arose from a review conducted by the Pharmaceutical Benefits PricingAuthority which looked at the pricing of various strips that were listed on the scheme. Therewas concern that there was a difference in price between strips, and various options were beingconsidered. I must stress that there was no decision made on any of these options. Optionswere put up to the government. Before any finalisation of the options was made we suggestedto the parliamentary secretary that we should go and consult with stakeholders in thecommunity. That we did and one of those stakeholders was Diabetes Australia. I am afraidthat they got it a little wrong and went to their members saying that we were going to do acertain thing when that was not the proposal.

Senator WEST—So diabetics will be able to access test strips for their glucose monitormachines irrespective of the monitor machine brand?

Mr Stevens—There has been no change to what is currently available and there is currentlyno proposal before the government to change that.

Senator WEST—So they can breathe easy for another six months, 12 months or forever?

Mr Stevens—I cannot answer for the future. All I can say is that currently there is noproposal to change.

Senator WEST—So that is before the department. Is there a proposal before PBAC?

Mr Stevens—PBAC has not been involved in this issue at all. It was a pricing matter. Thepricing authority has not got an active proposal in front of it.

Senator WEST—I had some very scared and worried diabetics who have the newermonitors with the more expensive test strips who find the new monitors more effective, moreaccurate and easier to read, because they are getting diabetic blindness and those sorts ofproblems. Are you doing something to reassure the diabetics of Australia that this is not underconsideration?

Mr Stevens—Yes.

Senator WEST—Thank you for that.

Senator FORSHAW—Can I take you back to the issue that Senator West referred to earlier.You also mentioned, Mr Stevens, the results of a study into the therapeutic group premiumsystem commissioned by the Pharmaceutical Manufacturers Association. I appreciate that youstill have to get a copy of this report. I would just like to put to you a couple of commentsthat they have made to see whether we can get a response at the moment. Correspondencesent to me stated:

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Given concerns, the industry commissioned Paul Gross of International Health Financing ConsultancyHealth Group Strategies Pty Ltd to prepare a report on the experience of TGPs internationally and thelikely impact of the government’s TGP proposal. A copy of his report is enclosed.

The major conclusions which can be drawn from this report are as follows:

1. The health outcomes of individual patients would be compromised if their access to modernmedicines is based less on medical need and more on their ability to pay any premium;

2. Costs to patients may be far higher than the $2 estimated by the government and could range up to$18 more each month;

3. TGPs will not only fail to reduce PBS expenditure but will increase costs in other parts of the healthsystem, notably medical services and public hospitals;

4. The government’s TGP proposal is inconsistent with its own health policies, such as the quality useof medicines and evidence based medicine; and

5. TGPs negate the benefits of other government policies which aim to foster pharmaceutical industryinnovations, such as the pharmaceutical industry investment program, clawing back almost double the$300 million allocated to PIIP to encourage investment.

They make a number of similar comments in a press release. They say that TGPs will sacrificeoptimal patient care for cheap patient care, thus putting the health of patients at risk,particularly the elderly and people with chronic conditions. They further state:To this end, we are calling on the government to delay implementation of the TGP proposal and toestablish a consultative forum involving key stakeholders in the health care sector to review possibleoptions.

I appreciate that you have not got a copy of the actual report that was released yesterday ortoday, but could you respond to those findings at the moment? Given that presumablysomebody somewhere made an examination of this proposal and would have presumablylooked at issues such as the impact upon costs, the impact upon patient care, the impact uponthe ability of doctors to prescribe the most appropriate medicines, do you have a response tomake about this at this stage?

Mr Stevens—At this stage all I can say is that we are anxious to get a copy of that report.We will be studying it and putting it in front of our experts and we will respond to it then.

Senator FORSHAW—That is a very safe approach, Mr Stevens. I certainly would not havethought that you would do anything else. It is important for other reasons besides the fact thatthe report that has been commissioned by APMA looked at international experience—andSenator West referred to just one instance. Did anybody anywhere undertake similar researchbefore this proposal was put forward in the budget?

Mr Stevens—I will defer the answer to that. Certainly there was some research undertaken.I do not know the extent of it.

Senator FORSHAW—Could you take that on notice and let us know precisely what workwas done and who did the work on looking at the operation of this type of system and relatedissues elsewhere in the world? On the last occasion we actually asked for the model uponwhich the savings that this system was going to produce were calculated to be provided. Icannot put my finger on the specific answer that was provided. My recollection was that thatwas not provided and we were told that the minister would need to consider the advice beforefurther information could be released.

You may have to take this on notice. Given that the manufacturers association commissioneda report, had a look at international experience, made some findings with respect to thefinancial impact on the health system in a number of respects, will the department provide

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its models whereby it calculated the savings to be made on this measure so that we can doa comparison?

Ms Murnane—This was information that was supplied in the context of cabinetdeliberations in relation to the budget. The information is confidential and for that reason wewill not be supplying it.

Senator FORSHAW—I hear what you say. The difficulty is that it makes it a bit hard toknow how the department is going to respond to the assertions made by the manufacturersassociation based upon the report that they commissioned if you are not prepared to make theinformation publicly available. Presumably the government would seek to rebut their findings.Maybe they will not. Maybe they will sit down and consult and work their way through thisissue. It is a bit of a one-way contest otherwise.

Ms Murnane—What we said last time, and what I am saying again, is that we will notsupply the information on the costing models for the reasons I gave. You have referred to areport. Mr Stevens said that we need to study that report. We need to have it studied by ourexperts and we need them to advise us. We need to take that step before we consider the otheraspects of the question that you raised.

Senator FORSHAW—I do not quibble with that. I fully appreciate that you have to geta copy of this report and analyse it. But, equally, we would also like to be able to considerand have our experts do the same sort of work—in other words, to be able to test what thegovernment asserts will be the results of this measure, both in terms of the savings to thescheme and in respect to its impact upon other aspects of the health system. For instance, asthe association asserts, it will lead to increased costs upon the health sector in other respects.How are we to judge or determine whether the government’s views on those issues havecredence or not if we are not able to get behind the assertions and actually have a look at thedata, in the same way as you will want to assess the report commissioned by the manufactur-ers?

Ms Batman—One of the crucial issues that I think might help in this is that people oftenmake assumptions about what the scheme is that the government is undertaking, and a lot ofpeople misunderstand. One of the things that we would be doing in looking at the report ismaking sure that we are looking at apples and apples rather than apples and oranges, so thatit would be fairly clear cut to say that the assumptions made about a scheme that has certaincharacteristics cannot be lifted over to another scheme that has different characteristics. Ananalysis of the report where, for example, they may not have the scheme as the governmentintends it to be would make it fairly clear cut and easy for you to see the department’sanalysis.

There are a whole variety of schemes called therapeutic group premiums. They depend onwhat sort of health system you have, what sort of pharmaceutical benefits are available anda whole range of things. There are often the crucial differences, and the costs within the systemmove about in different ways. What might help is to look at those issues first before you evenneed to get to issues about whether the costings are right.

Senator FORSHAW—I appreciate the assistance that you are endeavouring to give but,at the risk of getting off-side with the Chair—who is temporarily not here, so I am probablyon safe ground—we do not get too many shots at running our eyes over these figures. Thebudget papers indicate that you are going to save $41 million in the current financial year,substantially increasing over the next three years: $157 million next year; $173 million in1999-2000; and $188.7 million in the year 2001.

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What we have asked for on a previous occasion—and if we have not precisely done it, thisis what we are looking for—is the basis upon which you have come up with those calculationsand, in the process, what assessment would have been made of consequential impacts uponother areas of the health system as a result of this measure, and whether they were even takeninto account. What I am being told is that we cannot have that information because, as a resultof the budget process, it is confidential. It makes it a bit hard to challenge any of these figures.

Senator Herron—I can only assume that it was a decision made within the cabinet.Senator FORSHAW—This is a very dangerous thing to do today, Minister!Senator Herron—Consistent with our charter of budget honesty, which we brought in and

which the previous government did not, we will provide you with as much material as isavailable. We will take it on notice for you and give the material to you.

Senator WEST—That would be wonderful.Senator FORSHAW—That would be good if we can get it. It has got nothing to do with

budget honesty; it is to do with assessing this.Senator Herron—It is. We brought in something that you did not and, consistent with that,

we will give you as much material as is available.Senator WEST—Yes, like taking Lamisil off the list.Senator FORSHAW—So you brought in a charter of budget honesty that supposedly tells

me that what you say is going to occur in the year 2001 will actually occur?Senator Herron—No, I never said that.Senator FORSHAW—That is what your budget statement says.Senator Herron—I wish that was possible. We are telling you of the assumptions that are

being made on which the decisions are made.Senator FORSHAW—That is what we are interested in finding out.Senator Herron—We will give you what is available and what is not subject to cabinet

discussion.Senator WEST—Otherwise we will have to live for 30 more years and wait to see the

cabinet documents then.Senator FORSHAW—I do not want to keep us here all afternoon, but I think you now

have, as he said, the manufacturers association out there saying that they have commissionedsome work that challenges the assumptions or the views of this government about what impactthe measure will have. We would like information as to how you derived the resultant figuresin order to compare them. If you have got to go away to determine whether or not that canactually be provided for all sorts of reasons, I will await the outcome of the process.

Senator Herron—The Pharmaceutical Benefits Scheme started more than 60 years ago—allalong with successive governments judgments have been made as to what would or whatwould not be covered.

Senator FORSHAW—I am not sure, Minister, why you keep raising these things.Senator Herron—You are questioning the right of governments to make decisions in

relation to the Pharmaceutical Benefits Scheme.Senator FORSHAW—Chair, there he goes again. I am asking for some specific information

about the calculations that were made by the department on the savings of this measure. Thatis all I have asked for, and I have been told that it cannot be provided because it is

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confidential. Senator Herron, I do not know why you want to now start bringing in issuesabout whether it has changed or has not changed. We were not even talking about that. Sothat is what I am asking for.

CHAIR —You have been given an answer. We move on.

Senator FORSHAW—I was not sure what the answer was.

CHAIR —Would the minister like to give it again?

Senator FORSHAW—While you were out of the room, Chair, Ms Murnane said that couldnot be provided because of the confidential aspect.

Senator Herron—We can give you the outcomes but we cannot give you the assumptions.

Senator FORSHAW—Sorry, would you repeat that?

Senator Herron—We can give you the outcomes, which you have already got, I think.

Senator FORSHAW—You are giving me what I have already got.

Senator Herron—We will give them to you again. We cannot give you the assumptionson which they are made because they are subject to cabinet discussion. In other words, youare not going to get them.

Senator FORSHAW—Before we move on, as for the request by the association to delaythe implementation of this measure and consult with the government, presumably they wouldwant to consult with the government about the findings of their report and how that stackedup against the government’s views on the impact of this measure. Will the governmentconsider that request but I suppose, given your answer, is there any purpose to it anymore?

Ms Murnane—Senator, Ms Briggs has already referred to an expert committee that is nowadvising the government—the department—on the implementation of this measure. We havealready said that that report would be studied by the department and that expert committee.

Senator FORSHAW—But, Ms Murnane, my question was that the association hasspecifically asked that the implementation of the measure be delayed pending consultation onthe issue, and I asked if the government would give consideration to that request.

Ms Murnane—The date of implementation is set at 1 February. It is now the middle ofAugust. We are working on the supposition that there is sufficient time to have consideredthis report, other evidence and the claims that have come up at this hearing too by the expertcommittee and by the department prior to the implementation date.

Senator FORSHAW—Thank you for that information. It was not quite the question I askedbut I think I can extrapolate from that what your answer is. My question was: they have madea request. Will the government consider it? I would have thought the answer would be yes,no or ‘we will take it away and find out.’

Senator WEST—Can I just make very clear where an article I was quoting from comesfrom? It was an article by Catriona Bonfiglioli—

Senator Herron—Could I just interrupt you on a very minor point. One of my daughtersis named Catriona, and it is pronounced with the emphasis is on the second syllable. It is theScottish Catherine. All the Catrionas in the world would be grateful if it was pronouncedcorrectly.

Senator WEST—Anyway, that was the article quoting Dr David Wong, the secretary ofthe College of Dermatologists, and it was out of theAustralian Doctor Weekly.

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Senator Herron—The Australian Doctor Weeklyis not a publication of the AustralianMedical Association.

Senator WEST—No. That is why I was making sure that it was referenced.Subprogram 2.3—Acute care

Senator WEST—In question 397 on palliative care, referring to the development of anational palliative care minimum data set jointly funded by the Commonwealth and theVictorian government, I asked when we could expect that to be released. It was originallyexpected to be released in April 1997. The answer was: a final report on the development ofthe national minimum data set for palliative care is expected to be received by the end of June1997. The end of June has come and gone. Do we have the national minimum data set forpalliative care?

Dr Loy —Nearly.Senator WEST—Nearly. I am not holding my breath, Dr Loy.Dr Loy —A draft report has been submitted to the National Health Data Committee, who

looked at it from the point of view of making decisions about whether the minimum data setsshould be recommended for inclusion in the standard collections by the states. There was adiscussion of the report at that meeting and the report will now be finalised, I am told, byOctober. But I do not want to draw this out; I am happy to make the draft report availableto the committee, with the qualification that there can be further work done on it.

Senator WEST—Sure. I will follow it up in November. Thank you. What is the delay? Isit unforeseen circumstances or is it turning out to be more difficult than anticipated?

Dr Loy —I think it is people being more optimistic about when they can produce thesethings than actually turns out to be the case. I can quote you the number of data items thathave been reviewed and all that kind of stuff, but it has just proved to be a more difficult taskthan people estimated a while ago.

Senator WEST—This is the one that is being done by the Victorian department?Dr Loy —That is correct.Senator WEST—Okay. Thank you. That is all I have on that.Senator FORSHAW—I have some questions on private health insurance. There are not

that many.Senator FORSHAW—I have some questions on private health insurance. There are not

that many. On the last occasion, we got some information with respect to increases inpremiums for health funds. The information I sought was the average increases for each fund.The figures that were provided were an average increase across the industry since about 1983.Do you recall providing that material? I am trying to find it in the actual—

Senator Herron—Do you have a reference for me?Senator FORSHAW—I am actually trying to locate it myself. I think the answer that was

given was that you could not provide specific levels of increase on a fund-by-fund basis priorto 1996 because that data was not available. I accept that answer. I just cannot locate thequestion at the moment. What I would like, if you have not already provided this—I do notthink you have—are details of the increases that have been approved or sought from healthfunds since we last met, which was in June of this year.

Dr Loy —Senator Forshaw, you frustrate me constantly on this question because I alwayshave a table prepared and it is not the one that you ask for.

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Senator FORSHAW—That is my job. Your tables are always very illuminating in anyevent, Dr Loy.

Dr Loy —Indeed, and I do have one on premium increases since 1 September 1996 as at14 August 1997 and premium increase notification since 1 January 1997. We have not redonethat table since 2 June.

Senator FORSHAW—You have not redone that one?Dr Loy —The table goes up to the current date, but it starts at 1 September or 1 January.Senator FORSHAW—Is that the same table that you provided to me in June?Dr Loy —It is the same structure, yes.Senator FORSHAW—Same structure?Dr Loy —Yes, it has the health fund name, average per cent increase across the fund,

number of years since last increase, average increase per cent per year and number ofmembers.

Senator FORSHAW—If it is the same document that you provided to me last time, I donot need it again. If it is not, I would appreciate a copy.

Dr Loy —The difference is that it brings it up to date.Senator FORSHAW—I would like a copy. When you say it is up to date, is that because

it has been prepared today or in the last couple of days, or does it actually include all increasesthat have been applicable or sought up to date? In other words, what is the cut-off pointmeasuring the—

Dr Loy —It is 14 August.Senator FORSHAW—So that would include reference, I assume, to the increases by HCF

from 1 October this year?Dr Loy —Yes.Senator FORSHAW—What figure do you have for the HCF increase to apply from 1

August?Dr Loy —I have 12 per cent average percentage increase across the fund.Senator FORSHAW—And the last increase by HCF was when—a year ago?Dr Loy —Yes.Senator FORSHAW—And that was, from memory, 10 per cent, wasn’t it? Can you refresh

my memory?Dr Loy —That is my memory also, though I would need to check that.Senator FORSHAW—It is in the information you provided last time. I would like to

provide you with a letter. I do not wish to table it because I do not want to identify the personwho is involved. It is a contributor to HCF. The letter is from HCF to these people. I will giveyou a copy later. I want to read part of the letter from HCF. It reads:Rising health costs will require HCF to increase contribution rates for hospital and extras cover from 1October 1997.

It goes on:The cost of your hospital and extras cover will increase from $187.60 to $208.00 a month. The new ratewill apply to any payment you make from 1 August 1997. You can, however, maintain your current lowerrate for up to 12 months by paying your membership fees before 1 August 1997.

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Presumably, that is if you pay for the full year. It continues:If you are eligible for the Government Private Health Insurance Incentive Scheme and have applied orintend to apply for a reduction in your premiums, please note that the new rate does not include thisreduction.

And then there is some other comment. That letter, dated 25 June, was sent to a husband andwife who are contributors to HCF. The following letter, addressed to Mr Smith, the ChiefExecutive Officer of HCF, was forwarded in response. It says:We acknowledge receipt of your letter of 25th June.A few weeks ago I completed the form—

I am not sure what form that is—in the understanding that the Government was introducing a scheme whereby contributions would bereduced by those—

it says ‘by those’ but, presumably it should say ‘for those’—on low incomes. Instead we find that you are increasing our payments from $187.60 to $208.00 per monthan increase of $20.40. This is a substantial increase for us who are entirely dependant on a pension. Yourcosts may increase but our pension doesn’t. You deal in millions but we deal in dollars and cents. Alsoit is noted that you come in with this extra charge before we hear from the Government if it will in anyway reduce our payments.For us it has now reached breaking point as we still require the pension to cover the ordinary necessitiesof life.

That letter was sent on to the opposition, and was attached to a letter to us which states:Attached is a copy of a letter which I have sent to the H.C.F. in reply to the letter from them . . .

They are the two letters I have just referred to. It continues:May we please have your support as at this stage we don’t know if this Liberal Government will coverour extra payments or reduce them in any way.The completed form was sent to the H.C.F and they get in first with the extra charges. I am 80 years ofage and my wife a few years younger and we cannot take the risk of not getting prompt medical attentionif required.

I appreciate that we do not have all of the information regarding the circumstances and thetype of cover, but the increase that that pensioner couple is being faced with is $20.40—a 10.8per cent increase in the range that you have mentioned. Presumably, they had an increase lastyear. We have an incentive scheme coming in which I would assume they would not qualifyfor.

Dr Loy —Why would you assume that?Senator FORSHAW—If they are not taxpayers, how will they qualify for the rebate?Dr Loy —The incentive scheme has two aspects. It is, in essence, a cash payment which

comes off the premium, and you can apply to have it done that way or you can apply to haveit as a tax rebate.

Senator FORSHAW—So they qualify for a cash rebate?Dr Loy —I would think that is most likely, yes.Senator FORSHAW—Since the government came into office, they have had two increases,

one can assume. No doubt they have had private health insurance for some time and they donot wish to leave the fund. They have been doing the right thing, according to what thegovernment wants. They have had increases in the order of another 10 per cent. The valueof that tax incentive has virtually been eaten up in increases in premiums since the scheme

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was first announced, and it has only just come into operation. The first payments would notbe made for another 12 months.

Dr Loy —No, that is not so.

Senator FORSHAW—When do they receive their cash refund?

Dr Loy —As soon as it is processed. Clearly, it has been, to coin a phrase, ‘bloody awfultiming’ if they had applied for the incentive payment and had not received it at the time theyreceived the notice of the increase. That is most undesirable and upsetting timing. But, if theywere eligible for the incentive payment, it would simply be a matter of processing it and theywould then be paying a lower premium as a way of receiving that incentive payment. Thatwould come into force immediately.

Senator FORSHAW—We assume that they filled out the form, sent it off to the fund andset in train the process to get the refund back. They then got a letter which said, ‘Your fundpremium is going up by another 10.8 per cent on 1 August.’

Dr Loy —I cannot but repeat that that was bloody awful timing.

Senator FORSHAW—Would you agree that it is a bloody awful situation for this 80-year-old pensioner couple to be in?

Dr Loy —I can only make the point that the increase in costs and premiums would haveoccurred irrespective of the existence of the incentive scheme. At least the incentive schemewill give them the assistance that it does.

CHAIR —In other words, some incentive is better than no incentive.

Dr Loy —The incentive scheme has not changed the cost structure of the industry per seand HCF, like all the funds, would be facing those increasing costs now irrespective of theincentive scheme so their premiums would have gone up. At least with the incentive schemethey will get that relief. It is a pity that the timing worked the way it did.

Senator FORSHAW—What happened to the encouragement? I think we debated this oncebefore and it was said that there was no instruction—I would put it as a request—but therewas certainly communication from the government to the funds along the lines of, ‘Why don’tyou give the incentive scheme an opportunity to work and consider that’- the fact that thescheme is coming in—‘when you’re considering whether or not you will be seeking furtherincreases in premiums?’

That was an attitude expressed by the government to the funds, because ever since thisscheme was announced we have had this running problem. Concurrent with the lead-up to theintroduction of the scheme, and all of the advertising and whatnot just prior to 1 July toencourage everybody to get into private health insurance through this process, we had thefunds increasing their premiums at the same time, which was certainly not what thegovernment desired. What has been the response to your requests or pleas to the funds? It doesnot appear that there has been much notice taken of it.

Senator Herron—I think the funds gave the same response when your government madethe same request.

Senator FORSHAW—I am asking you, Minister, specifically, what has been the responseto your government, because it is your government’s initiative to give an incentive to peoplewho are not in private health insurance to join a private health fund? It is your measure, sowhat has been the response?

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Senator Herron—The funds’ response always is, of course, that the ageing population andthe increased costs of health care requires them to be fiscally prudent. That is their response,and it has been their response for as long as I can remember. It was the same response thatyour government got. Time will tell whether the incentive is sufficient to stem the exoduswhich occurred under your government where we went from something like 66 per centprivately insured down to 30 per cent, as it is now, as a result of your government’s initiativesand disincentives for people to take out private health insurance.

I am surprised to hear the crocodile tears coming, now that you are in opposition, about whatis occurring when one considers that no incentives were ever given by the previous governmenteither to keep people in private health insurance or to encourage them as new subscribers.

Senator FORSHAW—Minister, I am happy to debate those issues with you at any time.I do not think we have time today. I do not accept all of what you say. I obviously acceptthere is a decline. I think you know and I know that a major part of the reason why peoplecontinued to leave private health insurance was because of the substantial gap between whatthe funds refunded, particularly for medical costs in hospitals and what was charged.

I can give you chapter and verse of people who found themselves in positions whereschedule fees, for instance, for hearing operations were in the order of $850 and the chargeswere $2,500 to $3,000. People found themselves paying more in terms of the gap than whatthey ended up paying in health insurance. So there are a lot of reasons which, in many cases,have absolutely nothing to do with the government or incentives or disincentives but have todo with the costs of medical treatment. I put it to you that is one of the major reasons whypeople do not see any value for money in private health insurance.

Senator Herron—There are certainly specific procedures where that occurs, but your factsare incorrect. If the figures for the gap when you take into account the fees charged and therefunds—and I asked the same question that you just asked about three years ago and it is onthe record; I asked Dr Loy as a matter of fact and I have it indelibly impressed on my mind—

Dr Loy —It was an excellent answer.

Senator Herron—It was an excellent answer but it was a great question too, because it gotrid of one of these myths that is now being peddled by Senator Forshaw.

Senator FORSHAW—I bet he was not being so kind to you on that occasion, Dr Loy.

Senator Herron—It was an absolute myth because the average gap of a hospital episode,that is the hospital cost, was in the vicinity—and Dr Loy will know the figures better thanI do—

Dr Loy —I have forgotten them.

Senator Herron—The average gap was somewhere in the vicinity of $100. It may surpriseyou because you have to take into account the bulkbilling of X-ray procedures, the pathology,et cetera.

Senator FORSHAW—I saw the same charts.

Senator Herron—The average out of pocket gap for a medical procedure was in the vicinityof $20. Those facts are on the record.

Senator FORSHAW—I recall that information. I sat in the committee with you, I think,when you were actually asking questions about—

Senator Herron—That was even before you came into the Senate.

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Senator FORSHAW—No. I recall you being in a hearing in this building when you werereferring to that, trying to refute this argument. I do not want to continue it beyond makingthis point—

Senator Herron—Let us get the facts right.

Senator FORSHAW—The facts are these: you continue to use average statistics. Okay,that will tell you one story. The point is this: the numbers of people who look at having privatehealth insurance or who feel a need to continue having private health insurance cannot justbe described as an average. For instance, obviously people who can expect to have substantialmedical bills because of a particular condition they have—I can give you specific examplesof this; hearing problems—where they more than likely may have to have complex surgeryon more than one occasion therefore see a need to be in a private health fund if they want tohave a specialist of their own choice and so on. They are very often people who will take theview that they should have private health insurance.

You will find the substantial gaps between what is charged and what is refunded in thosesituations. Whilst you may be able to average all those figures and come up with the figuresthat you have just given, when you actually look at specific procedures and the situation ofpeople in a whole range of groups, depending upon their medical needs and medical prognosis,I think you get a far different story. Anyway, we have debated that for a while.

Senator Herron—You have just given the argument for the government incentives schemesto try to attract younger people into private health insurance so that we can continuecommunity rating.

Senator FORSHAW—The question I was asking was that the incentive, which is utilisingtaxpayers’ funds and funds that could have necessarily been used in other parts of the hospitalor medical system where substantial cutbacks occurred, such as the reduction in funds to thestates in hospitals, is to try to encourage people to take out private health insurance. What weare seeing, for instance, are pensioners who have supported the system probably all their livesand stayed in it at great cost to themselves getting hit again.

Yet this incentive is supposed to be about increasing membership so the burden gets sharedso that people like the ones in the examples I have quoted will not continue to have to meetever increasing premiums of the magnitude we have referred to. It appears to me that the fundsare really disregarding the incentive scheme and the supposed prospects of additionalmembership to help defray increased costs when it comes to considering increased premiumson their existing members. I think you have confirmed it. Is that a yes, Senator? It is a nod.

Senator Herron—I have had similar discussions with the private health insurance fundsalong those lines.

Senator FORSHAW—Is the government or department doing anything about talking tothe funds and saying, ‘Look, you have introduced an incentives scheme. People are beingencouraged to take out fund membership. They are all going to get taxpayer funded rebates,including funds that will come from non-members as well as members of health funds. Whydon’t you just put a moratorium on increases and let us see what happens?’ Has that been putto the industry or don’t you care about what happens?

Dr Loy —I find myself a bit surprised to be in a position of a defender of the funds but sobe it. While on the one hand we would be delighted, and certainly I know the minister andthe Prime Minister and the Treasurer would be delighted if they did not receive any

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applications for premium increases, nonetheless the situation in the industry is that they arefacing substantially increased costs. They do have to maintain a level of reserves to be prudent.

We would certainly question any application that seemed to be based upon wanting tomaintain an excessive amount of reserve but that is not the case. For us to be in a positionto essentially drive funds into losing money—and they did lose a lot of money last year—andto threaten their viability would not be sensible policy. I think the government did act throughthe incentives, and there needs to be continuing examination of issues and measures to attemptto control the increasing costs and to bring a wider cohort of people into private healthinsurance, as you said, to spread the risk.

Senator Herron—I think we agree on the basic parameters. We have a rapidly ageingpopulation. Two-thirds of the health care dollar is spent on people over the age of 60. Thatis not going to change. That is going to accelerate. By the year 2000, 15 per cent of thepopulation in this country will be over the age of 60. We have to face up to the fact that thecost of health care will increase. In addition to that add the various new procedures and newtechnologies that are coming on and are available. We all agree on that.

Senator FORSHAW—Do not start me off again please, Minister. Can I stick to thequestions?

Senator Herron—Your government never refused any increase from the health insuranceassociation in your 13 years.

Senator FORSHAW—I have heard that stated before.

Senator Herron—It is true.

Senator FORSHAW—I know what you say. I do not dispute that. What I am pointing outhere and what I am seeking some response on is that what your government has done that isdifferent—if you want to compare—is take $1½ billion of public funds and say, ‘We will paythat as a $450 incentive to people who take out or who have private health insurance.’ Thatis a massive amount of money that is being paid as an incentive for people to take outinsurance. If $1½ billion is going to be put into that sort of scheme it is reasonable to expectthat the industry, which is ultimately intended to be the ‘beneficiary’—and I put that in quotesbecause it is intended to improve the position of the fund membership and ultimately theirfinancial position—would have a bit of regard for this government initiative, the use of thisamount of taxpayers’ money and take it into account when they are applying for premiums.The distinction is that under our government there was not that $1½ billion worth of taxpayers’funds being put into the system to prop the funds up. You can argue about the merits of that.

Senator Herron—With the spiral of 66 per cent down to 30 per cent. They are gettingthrough on the public hospital system.

Senator FORSHAW—What is wrong with the public hospital system? But that is anotherargument.

Senator Herron—It is trying to cope with the numbers.

CHAIR —Can we move along?

Senator FORSHAW—When the applications for increases come in is any considerationgiven to the fact that you now have this scheme where $450 will be paid or is that totallydisregarded?

Dr Loy —I do not understand the question. Can you repeat it?

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Senator FORSHAW—Senator Herron said earlier, and the Chair has said it on previousoccasions, that under the Labor government all applications for fund increases were approved.We never knocked one back. We keep hearing that rhetoric.

CHAIR —It is fact not rhetoric.

Senator FORSHAW—We keep hearing that factual rhetoric. The position now is that inaddition to having the usual flow of applications for fund increases what we have is thegovernment agreeing to pay around $1½ billion in public funds as an incentive for people tojoin and remain in health funds.

Dr Loy —That in and of itself does not lead to any increased flow of funds to the registeredorganisations because obviously they reduce their premiums by the amount of the incentive.We would be very cross if they did not do that.

Senator FORSHAW—But they are not reducing their premiums. They are makingapplications to increase their premiums.

Dr Loy —The HCF letter that you quoted said that the numbers we are quoting do not takeinto account the incentive. If you are eligible for it then the amount of the incentive comesoff the premium.

Senator FORSHAW—But that is an administrative issue. The point here is: is the purposeof the incentive to encourage more people to join funds and to encourage people to stay infunds rather than leave them?

Dr Loy —Correct.

Senator FORSHAW—For public policy reasons the government has decided that theybelieve that is in the interests of the health system. It is also clearly to assist the private healthinsurance industry by encouraging people to join their funds. That is a new factor in theequation when it comes to considering applications for fund increases. All I am asking is: whataccount is the government taking of the existence of this scheme when it considers applicationsfor increases in premiums? Do you take it into account at all?

Dr Loy —We examine the projections that the fund makes. When a fund puts in anapplication for a premium it would provide information on its projections of income andoutlays over the next 12 months. We examine those to see if they seem reasonable from ourpoint of view. I think if we imposed upon funds an assumption that there are going to besubstantially increased numbers of funds over the next 12 months, I do not think that wouldbe a sensible piece of policy.

Obviously, if a fund were assuming there would be no effect of the incentives whatsoeverand they would lose members hand over fist we would question that assumption. That is whatit turns on. What are the assumptions that the fund has made about numbers of members andpremium income and outlays over the next 12 months? Are those assumptions reasonable?What effect does it have on their reserve levels? While there are a couple of for profit funds,profit does not enter into this as an issue in terms of being important for premium increases.It is the issues that were outlined in the Industry Commission report which are the drivers ofpremium increases.

Senator FORSHAW—God forbid—do not raise the Industry Commission!

CHAIR —Can we move along. We are going around in circles here. Are there any furtherquestions?

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Senator FORSHAW—With respect, Chair, it would assist if I were allowed to ask thequestions—

CHAIR —You have been asking them all right.Senator FORSHAW—And I will continue—CHAIR —So if we can move along.Senator FORSHAW—Your job is to sit here and chair this committee—CHAIR —That is dead right.Senator FORSHAW—And you are paid quite substantially and handsomely for doing that.

My job is to be here and ask questions—CHAIR —You are a kid.Senator FORSHAW—And the task of the officers here is to respond. That is what I am

asking to do.CHAIR —‘My job is to ask questions. I’m a kid.’Senator FORSHAW—Good.CHAIR —Go on, be a kid. Ask the questions. Let’s move on. We are going round in circles.

All I am asking is that we move on and not be like the kid in the ad and ask mindlessquestions retracing every other one. I am quite happy to have any question you like, as longas we do not just go over and over the same question. Do you have any further questions thathave not been answered on acute care or private health insurance? If not, we will move onto 2.4—mental health.

Senator FORSHAW—Have you finished? Dr Loy, are you able to give us any preliminaryindication as to what the increase has been in fund membership since the start of the schemeon 1 July? I realise it is very early, but there were reports in the papers about substantialinquiries being made to the funds. Do you have any data at this stage?

Dr Loy —No. The figures for June quarter membership will be available shortly, but againthat will be before the impact of the incentives has taken effect. We have some figures forthe amount in incentive payments being made in July and August, but again that is really justan indication of the number of people who have so far taken up the option of receiving theirincentives through the effect on premiums rather than through tax rebates.

Senator FORSHAW—Forgive me if you regard it as a mindless question, but we will notget another chance to ask you until October—at least in these estimates proceedings.

Dr Loy —It does not seem very far away.Senator FORSHAW—It is not that far away, but it would assist if you were able to give

forward information to the committee when you do have some indication as to what responsethere has been to the initiative. There is another question which is related to that: are you ableto say what level of fund membership new members are taking up? As you know, there werereports—I asked questions about this on the last occasion—that people who are not membersof a fund would be able to join a fund, take out the lowest discounted product available andthereby avoid the imposition of the increased Medicare levy. I would be interested to knowwhether or not there has been any significant increase in that type of cover compared withany products that are available from the funds.

Dr Loy —We would certainly be happy to provide that as soon as we have it.Senator FORSHAW—Thank you.CHAIR —We will move on to subprogram 2.4.

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Subprogram 2.4—Mental Health

Senator GIBBS—I want to follow up on my question in June in relation to youth suicidein Australia and the national youth suicide prevention strategy. With the answer was sent agraph of the direct funding to state governments and the funding to state based services. Inotice in here that New South Wales received an extraordinarily high amount in proportionto the other states—more than double than was received by Queensland.

Dr Loy —Senator, would you be able to give us the number of the question so we can locateit in this folder?

Senator GIBBS—It is about the $31 million national youth suicide prevention strategy. Whyis so much allocated to New South Wales?

Dr Whiteford —That is a total aggregate of funds which has been provided not only to theNew South Wales government but also to other services funded in New South Wales. Forexample, the Hunter Institute for Mental Health in Newcastle may be funded for a nationalinitiative and other services for model initiatives. If they happen to be based in New SouthWales, that would come under that allocation. Only $2.1 million went to the New South Walesgovernment and $3.6 million went to other services in New South Wales.

Senator GIBBS—That is right. Even so, if you take the $2.1 million, Queensland received$0.194 and Victoria received $0.797 million. Does this indicate that more people in New SouthWales commit suicide than in Queensland and Victoria?

Dr Loy —I think what you are seeing there is that funding is substantially the funding forsupport for rural youth counselling services. That was distributed to states on the basis of aweighted formula that took into account the number of young people in rural areas. I thinkthat would account for the skewed distribution you see there. It is not just per capita; it is pernumbers of young people in rural areas weighted capita.

Senator GIBBS—Does your department have any control over how the states spent moneyin this regard? Can you direct them towards certain services or are other state governmentsleft to their own devices?

Dr Whiteford —It depends on the initiative. In some respects there are broad guidelinesabout how the money is to be spent. For example, that funding you are referring to has to bespent for services to young people in rural and remote areas. It cannot be spent outside of that.On other services we directly contract with the service and not through the state government.In that sense we have much more influence over those sorts of initiatives.

Senator GIBBS—Part of the answer I was given states that 280 people were employed onprojects. There was a total of $31 million. I take it that the $31 million takes in all of thisdirect funding—the state based services plus their wages. Is that correct?

Dr Whiteford —It takes in a lot more than that, Senator. That would take in the $6 millionon telephone counselling which is going to Lifeline and Kids Help Line. It would take in the$3 million parenting project. It takes in quite a range of things. Only a proportion of thatwould actually relate to the 280 people being employed.

Senator DENMAN—Can you explain to me the parenting program you just mentioned?Dr Whiteford —It is an initiative of the government. Some $3 million has been allocated

out of the $18 million in the budget before last for programs for parenting. That is an initiativewhich has been advertised, and it has not yet been awarded by the minister. We are lookingat programs which could enhance the skills of parents to deal with young people, especiallyyoung people who might be at risk of ultimately ending up in self-destructive behaviour. It

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is primarily a prevention initiative trying to get as early as we can where the problems mightstart to arise in families.

Senator DENMAN—So you are identifying the parents at risk as well as—

Dr Whiteford —I am identifying families at risk and recognising that parents with additionalsupport and perhaps more skills might be able to ensure that their children and adolescentsdo not end up in situations where suicide appears to be an option for them.

Senator DENMAN—I understand what you are doing. I was just thinking of particularfamilies on the north-west coast of Tasmania where I am. There have been three suicides inone family who would certainly not have slotted into what you have just explained to me. Thefamily would not have been considered a family that needed support with parenting skills. Thatis what I was getting at.

Senator GIBBS—Are you finding that a proportion of suicides are drug related? Why I askthat is that I have an interest in drugs. I went to a meeting of family and friends for drug lawreform. There was a woman there who originally had five children but now has only two.Three of them are dead. Her daughter shot herself through the heart. That was put down tosuicide, but it was drug related because she was in a rehab centre and they turfed her out andwould not take her back. She could not stand it any more. She was trying to get off methadoneand she shot herself. Are there any special areas that you are looking at like this? Are thereany special programs for this sort of thing? Is youth suicide working in with the drugs?

Dr Whiteford —Yes, Senator. Certainly there are a number of initiatives. I am just tryingto identify the ones which are particularly targeting a range of at-risk youth. This includesyouths who are homeless, youths who have mental health problems, youths who abusesubstances and examples like that. We have a number of initiatives specifically targeting youngpeople who are disadvantaged and who have a range of other problems which contribute tothe final behaviour which is self-destructive behaviour.

Senator GIBBS—In the programs, are there rehab centres or is it basically Lifeline?

Dr Whiteford —I can give you an example of the sorts of services which are being funded.The Jesuit social services in Melbourne are working with homeless young people in innerMelbourne. The Bennelong Haven Aboriginal Drug and Alcohol Rehabilitation Service in NewSouth Wales has been funded. A young women’s initiative project in Victoria and a numberof other projects like that are examples of trying to reach at-risk young people, and many ofthose at-risk young people abuse alcohol and elicit drugs.

Senator DENMAN—Has there been any funding to a Tasmanian group and which groupis it?

Dr Whiteford —I am sure there has been funding to a Tasmanian group. I will take thaton notice if you like.

Senator DENMAN—Thank you.

Senator GIBBS—Was there anything in there about Queensland?

Dr Whiteford —Not in that list, but there are programs funded in Queensland, and I couldcollate them for you if you wish to see the ones funded in Queensland.

Senator GIBBS—I would appreciate that, thank you.

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[5.10 p.m.]

Program 3—Aboriginal and Torres Strait Islander HealthSenator FORSHAW—It may be that the minister will wish to make some responses

himself, given his particular interest in the portfolio area. The questions that I have in thisprogram are essentially on behalf of Senator Bob Collins, who was unable to be here today.They follow on from some questions that he asked on the previous occasion. I think we willput them on notice. At the last hearing, Senator Bob Collins asked whether the departmenthad received any formal or informal direction from any of the central agencies—in particular,from Prime Minister and Cabinet, other departments, ministers or their officers—about thenature of the work being carried out by his department in response to the reportBringing themhome. The answer at that time was that there was no formal or informal direction. Is that stillthe case?

Ms Murnane—Yes, that is still the case.

Senator FORSHAW—I understand that some work on mental health is progressing. Is thatcorrect?

Ms Murnane—That is the case.

Senator FORSHAW—When will that be completed, and what will happen to the reportonce it is completed?

Dr Anderson—Over the last 12 months a strategic plan has been developed to shape thedirections in activities around emotional and social wellbeing in Aboriginal and Torres StraitIslander communities. In broad terms, the action plan spells out strategies to develop capacityin the Aboriginal and Torres Strait Islander mental health work force—strategies to developculturally appropriate therapies in Aboriginal and Torres Strait Islander mental health programsand strategies to develop a planning base for future activities. My colleague Marion Dunlopcan actually provide some further detail on this plan.

Ms Dunlop—The implementation of the action plan is well under way. The focus for thecoming 12 months is around the data and evaluation strategy and making sure that the projectsthat we have funded to date are operating effectively.

Senator FORSHAW—Did you indicate in your answer when that work would becompleted?

Ms Dunlop—I beg your pardon?

Senator FORSHAW—I am sorry, Dr Anderson, I did not hear the entire answer. Part ofthe question was about when that work will be completed. When will that be?

Dr Anderson—The strategy itself is applied—

Senator FORSHAW—How many years do we have to wait for a report?

Ms Dunlop—The action plan is well under way in terms of its implementation. The tworemaining areas where we need to focus our effort on the implementation of it are in the dataside of it and in developing the evaluation strategy, but the bulk of the funding under the planhas in fact been committed.

Senator FORSHAW—At the last hearing Senator Collins asked whether or not all stateshad signed framework agreements on Commonwealth-state cooperation on Aboriginal health.The advice at that time was that all states and territories except Tasmania and the NorthernTerritory had signed up. What is the position now?

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Dr Anderson—The position is unchanged at this time.Senator FORSHAW—So Tasmania and the Northern Territory still have not signed up?Dr Anderson—That is correct.Senator FORSHAW—Have all the other agreements been signed and completed; there is

nothing hanging over?Dr Anderson—In all other jurisdictions there has been an agreed framework which has been

signed off. The priorities for action over the next 12 months are actually implementing thecoordination that is outlined in those framework agreements.

Senator FORSHAW—What is the reason for the delay in finalising the financial agreementswith Tasmania and the Northern Territory?

Dr Anderson—These are not agreements that are tied to dollars; they are agreements thatcommit jurisdictions to a joint process of planning and a process for determining the data andneeds assessment processes that shape that planning. In the case of both jurisdictions, theagreement has stalled not on the content of the agreement but on discussions regardingsignatories to the agreement.

Senator FORSHAW—Any indication of when you think the Northern Territory andTasmania will be finalised?

Dr Anderson—We do not expect much further progress on the Northern Territory until afterthe election in the Northern Territory. We would hope to be able to progress the agreementin Tasmania expeditiously over the next couple of months.

Senator FORSHAW—As a result of the delay in signing an agreement with the NorthernTerritory, what has been the cost, if any, to the intended beneficiaries of the program?

Ms Dunlop—There have been some delays in identifying the remote sites under the remoteareas initiative for new services. As for working with Territory health, with the communitycontrolled sector and ATSIC, we are progressing that on an informal basis. There have beena number of very good meetings with all of those players in the last few weeks.

Ms Murnane—It is also relevant to add that two Aboriginal specific coordinated care trialsare in the design and set-up stage in the Territory at Katherine and on the Tiwi Islands.

Senator FORSHAW—When did the negotiations for this agreement start with the NorthernTerritory government?

Ms Dunlop—It would have been over 12 months ago.Senator FORSHAW—How far have you progressed with the establishment of performance

indicators to measure the performance of the Aboriginal health program? I am talking aboutthe Northern Territory.

Dr Anderson—Two sets of agreements have been reached in the last couple of months. Thefirst was with the Aboriginal Health Council in which the health council agreed to put in placefor this financial year a reporting framework for Commonwealth funded Aboriginal healthservices. The second was in relation to the health ministers meeting in Cairns on 1 Augustwhen there was agreement to put in place national performance indicators for Aboriginal andTorres Strait Islander health and to determine a process for the further development of thoseindicators. They are both very significant achievements in terms of the history of this program.

Senator FORSHAW—What about the other states?Dr Anderson—The national performance indicators cover all jurisdictions.

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Senator FORSHAW—Is it only in the Northern Territory and/or Tasmania where there isstill some delay in finalising the establishment of these performance indicators?

Dr Anderson—There are two processes. One is the framework agreements. There is a datacollection element within that, but that in itself is separate from the development of thenational performance indicators. The performance indicator processes are actually proceedingapace.

Senator FORSHAW—What I am trying to ascertain—maybe I have a misunderstandinghere, and correct me if I have—is that, even though you are developing national performanceindicators, you still have to get the states on board?

Dr Anderson—Yes.Senator FORSHAW—Are all the states and territories in the same position with that or

are some more advanced in the process than others?Dr Anderson—All at the health ministers council in Cairns agreed to the national

performance indicators.Senator FORSHAW—This was the same meeting in Cairns that we talked about this

morning?Dr Anderson—Yes.Senator FORSHAW—In the first budget brought down by this government last year there

was funding for an additional 35 Aboriginal centres. Is there funding in the 1997-98 budgetfor any additional centres?

Dr Anderson—That process has been staggered over two years—25 in the first year and10 in this budget.

Senator FORSHAW—So the 1996-97 budget allocated the money for two years?Dr Anderson—Yes.Senator FORSHAW—And there is nothing in this budget that goes beyond the 10 that were

already funded?Dr Anderson—That is correct.Senator FORSHAW—What are the overall budget allocations for Aboriginal health centres

in both last year’s budget and this year’s budget? Can you remind me of that? If you havenot got the figures in front of you, you can let me know or let Senator Collins know.

Dr Anderson—I will need to clarify that one.Senator FORSHAW—Are you aware of any support going to the Aboriginal health centres

through the CDEP—the community development employment program?Dr Anderson—I am aware that in some centres the programs actually run side by side. I

am not aware of the detail as to how that actually works.Senator FORSHAW—I should have explained the question a bit more, I suppose. Are you

aware of any centres where health workers or related workers are funded through the CDEP?Dr Anderson—I will need to take that on notice.Senator FORSHAW—Yes.

Senator Herron—It might be very difficult to obtain figures for that in the sense that thereis no restriction on CDEP if a community wishes to use them for that purpose. For example,I have been looking at a book here calledGrog War, and I recommend it. It is a detailed

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account of what happened in Tennant Creek in relation to control of alcohol. It mentions here,for example, that CDEP participants were used in the health project in relation to alcoholcontrol in Tennant Creek, and I am aware of many communities where that is occurring. Whilenot trying to restrict your information, it just might not be possible to get a precise figure ofall the CDEPs detailing how they may be used in relation to health matters.

Senator FORSHAW—I appreciate the point that you are making, that there is the abilityfor the community itself to determine how that money might be allocated. Nevertheless, if youcould see if you could obtain that information, because a follow-up question from SenatorCollins to that is: can you inform whether or not the cuts in funding in Aboriginal affairs, andparticularly in health, and the subsequent reductions in the CDEP programs have had an impactupon the delivery of the health services through the centres?

Senator Herron—There have been no reductions in CDEP programs. There has been anincrease in funding in relation to Aboriginal health, and we will get the precise figure for you.The only restriction in CDEP funding was in capital expenditure in CDEPs involving morethan 150 participants.

Senator FORSHAW—I will let Senator Collins read theHansard.

Senator Herron—I am sure he knows it.

Senator FORSHAW—I am sure he would not have written this question out for me if hedid know.

Senator Herron—He may be thinking of a specific CDEP, and I would be happy to getan answer for him on that. I have just been advised that Senator Collins may be referring tothe community youth support program rather than CDEP. Is it CDEP there?

Senator FORSHAW—Yes. The advice that I have got is CDEP.

Senator Herron—We will take that on notice and get back to him.

Senator FORSHAW—Turning to the Mabo-Wik Aboriginal land rights debate, there hasbeen considerable discussion in the public domain, in newspapers and elsewhere about therelationship between security of tenure for Aboriginal people over their traditional lands andtheir general state of health. In response to a question about why, despite the expenditure oflarge sums of money, Aboriginal health was not improving, Dr Wooldridge apparently saidthe reasons were that Aboriginal people were smoking more, drinking more and that there wasa general sense of despair within the Aboriginal community. I think that is reporting himaccurately, while not directly quoting him.

It seems that it is certainly a reasonable proposition that the debate that is currently takingplace about the future of native title rights and what changes might be made or proposed bythe government in that area as a result of the Wik decision could well increase the level ofdespair and feelings of hopelessness in the community. If there is a link between Aboriginalhealth problems and these issues, has the department undertaken any studies in this regard totest that more fully?

Senator Herron—There is no doubt that there is a link, but the response is that in theNorthern Territory Aboriginals comprise 25 per cent of the population, they have control of49 per cent of the land and have the same health problems as occur in the rest of Australia.While there is a link, it could be argued that there are many factors other than land control.

Senator FORSHAW—Is that a personal position you are putting?

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Senator Herron—No, that is a statement of fact. There is certainly a linkage betweendispossession and the state of Aboriginal health. I do not think anybody would argue againstthat. I am sorry, what was your specific question?

Senator FORSHAW—Has the department actually undertaken any studies into this claimthat, given the link, the current debate might even contribute to further problems?

Dr Anderson—The answer to that is no.

Ms Murnane—The department has been focusing on—in this area, particularly—improvingAboriginal health. With respect to the work that has been done, you mentioned mental health.There is also a strategy on sexual health. There is performance information across a wholerange of diseases that Aboriginal and Torres Strait Islander people are particularly vulnerableto. As well as that, there is now agreement between the Commonwealth and all the states onAboriginal health indicators, and substantial agreement, too, on targets for improvement onsome of those indicators which will allow us to mobilise resources to go into improvementthere, to track outcomes and to revise strategies depending on what the results are.

Senator Herron—The most encouraging thing that I have seen in the last 16 months wasthe program that was launched about a month ago by the Tiwi people. The Tiwi people—therewere about 35 at the launch—have undertaken control of their own health in their owncommunity on Bathurst and Melville islands. They are setting benchmarks and they have totalcontrol of their program, which is a first for this country.

Senator FORSHAW—Is this the Torres Strait?

Senator Herron—No, Bathurst and Melville islands are north of Darwin. It is quiteoutstanding. They have accepted responsibility for health prevention mechanisms with theirown people and also the delivery of treatment. That is a process that is being undertaken bythe department which is, I think, one of the most major steps forward, apart from thedevelopment of the Aboriginal medical services—of which the government has said there willbe 35 new ones in the next couple of years. Certainly, I would commend that one to anybodywho is interested in this field. It is the first—

Senator FORSHAW—Where was that? Bathurst and—

Senator Herron—Bathurst and Melville.

Senator FORSHAW—I seem to recall reading something recently—I do not know whetherit was about that or a related issue—and I do not want to misquote people or misrepresent theirposition, but I think an argument was being put that, whilst you may have made statementsalong those lines, that you also have to consider that there are certain differences betweensituations as they may exist on those islands or the Torres Strait islands and the situation thatmay exist in a community in the outback of WA or the Northern Territory. I do not want toparticularly pursue it.

Senator Herron—Every community is different. It is just that this was a first and it is goingto be a forerunner for the development of Aboriginal health care around the country.

Senator FORSHAW—I will return to the issue I was raising, and the answer has been giventhat this work is not being done. The real purpose behind the question was that even allowingfor what you have said—that work is being done and that there are improvements, et ceteraoccurring; I will not debate that—is the department doing it in a formal way and is itconscious, and keeping in mind, that there is a view being expressed that all of that good workmay well be undone if the end result of the WIK process is that Aboriginal people believe

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that they have lost rights? A link is drawn between health and native title rights, access andpossession.

Senator Herron—I understand the point you are making, but the counterpoint is that thelargest Aboriginal community in Australia is in Sydney—over 30,000 people. They are notaffected by native title rights at all. You have 49 per cent of the land mass under the controlof 25 per cent of the population in the Northern Territory. There are very few communities,numerically at least, which could be affected one way or the other. I would have to take adviceon that. There are 800 separate communities around the place. The Tiwi people will not beaffected because they have always occupied their land and there has never been any questionof dispossession.

Certainly all these things are interrelated. There is no question about the dispossession ofland and the affects that that has had on the Aboriginal people. It is a tenuous argument whenyou get down to the specifics of it in relation to communities as a whole.

Senator FORSHAW—I will leave it for Senator Bob Collins to pursue. I was asking thequestions on his behalf. Finally, in November last year you announced a strategy to use theArmy to put basic infrastructure in remote communities. You identified 300 communitiesinitially.

Senator Herron—No, I identified six.Senator FORSHAW—The program was subsequently revised down to a pilot scheme. That

is the six, is it?Senator Herron—Yes.Senator FORSHAW—How many communities have so far been assisted under this plan?Senator Herron—Six. It is still too early to evaluate how they are going—except one,

Oombulgurri, which was a specific item which was an emergency situation following acyclone. The Army went in. That is complete and there has been an excellent response fromboth the community and the Army.

Senator FORSHAW—How long is the pilot scheme intended to run?Senator Herron—Six months, initially.Senator NEAL—Has that six months ended?Senator Herron—First of all we had to get the agreement of communities. We had no

difficulties—the communities approached us. We got many more requests than we had moneyavailable. The limitation is the money. There has already been a program of identifying the60 communities that require infrastructure projects in relation to health—sewerage, water,roads, electricity, et cetera. Those 60 are proceeding in a two-phase process over a four-yearperiod.

Senator NEAL—So you are saying that in fact a lot of them have not even started yet—isthat correct? How many have actually started?

Senator Herron—I am not certain because some of them have been held up—Senator NEAL—Less than three?Senator Herron—Marion might be able to tell us.Ms Dunlop—The Oombulgurri one that the minister mentioned has been completed. That

was a quick one.Senator NEAL—How many have actually started?

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Ms Dunlop—The planning phase is under way for all of them, and there have been anumber of visits from the army, from ATSIC and from our department to the communitiesto establish the work plan. I cannot give you that information.

Senator Herron—They have all started in the essential planning.Senator NEAL—How many, except for that one, have actually started any work?Senator Herron—Physically on the ground?Ms Dunlop—I would have to give you up-to-date details on that.Senator NEAL—Would it be less than three?Senator Herron—Probably, but we will check for you.Senator NEAL—So it is almost certainly less than three. If there is less than three, it seems

unlikely you cannot remember. It is not a vast array to keep track of.Senator Herron—No, it is joint army-ATSIC. We will check for you. I cannot answer you.Senator NEAL—So you do not know? There is a figure of about three, but you cannot say

for certain how many have started?Ms Dunlop—There is a work plan for each of the communities, but I do not know exactly

which point they are at. I can get that information for you very quickly, though, as to wherethey are up to and whether they have actually gone in, because the planning is well under wayand there is a time frame for them to go in.

Senator NEAL—That is not the question I am asking.Senator Herron—If you want to know whether the army is on the ground there, we will

find out for you.Senator NEAL—It seems amazing that if there is a number of about three, you cannot tell

me. It is not a vast array of resources to—Senator Herron—With respect, it is. It is the involvement of the Australian Army—the

engineers, the advance people, the water, sewerage, drainage.Senator NEAL—It is obviously somewhere between one and three that have started and

you cannot tell me.Senator Herron—We will find out for you.Senator NEAL—I find that very peculiar.Senator Herron—The planning for all of them is done.Senator NEAL—I have heard that.Senator Herron—It is the availability of these specific personnel to go in, so it is not as

if—Senator FORSHAW—The planning for all of them being 60?Senator Herron—Six.Senator FORSHAW—At one stage I heard 60.Senator Herron—The 60 is the health infrastructure priority project program. It was a

separate program and it was out of that that we got the—Senator FORSHAW—So there are six in the pilot program?Senator NEAL—So six of them have got planning started?Senator Herron—Yes.

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Senator NEAL—We know that, but you cannot say, out of that six, how many have actuallystarted work? You cannot tell me? Is there anyone out of all the people here who could tellme?

Ms Dunlop—We would actually have to go back to the army because they are the ones whohave developed the work plan with the community and agreed the time at which they wouldgo in with the community, so we would need to go back and check that with the army.

Senator FORSHAW—Aren’t you monitoring? Minister, you announced this—Senator Herron—Daily.Senator FORSHAW—You announced this scheme with great fanfare.Senator Herron—It is the first positive action that has ever been done.Senator NEAL—It has not actually happened, has it?Senator Herron—I think it needed a good fanfare.Senator FORSHAW—Knowing how much ownership that you demonstrated you had in

this scheme, I would have thought that you would know precisely where it was at, given thatit is a pilot program.

Senator Herron—I also respected the cultural sensitivities of the communities involved.Senator FORSHAW—That has got nothing to do with what I am asking you.Senator Herron—Senator Collins will be pleased to have that on the record—that you said

that it had nothing to do with it at all.Senator FORSHAW—It has nothing to do with your knowledge of whether it started or

not. The question I am asking you is a factual question.Senator Herron—You are making the statement that you thought that there should have

been some dramatic action occur when it was announced six months ago, that we should bewell under way.

Senator FORSHAW—Stop trying to put words into my mouth. I never said that.Senator Herron—Perhaps it was Senator Neal.Senator FORSHAW—And I did not say that the cultural views of the community were

unimportant, as you just tried to assert.Senator Herron—It is on the record; I heard it.Senator FORSHAW—It is not what is on the record. We will read the record, Minister,

and we will check it.Senator Herron—If you want to modify it, that is okay.Senator FORSHAW—You tried to assert that is what I said.Senator Herron—No, it is on theHansardrecord. They will drop it back to you.Senator FORSHAW—That is right. We will read theHansardrecord and I will accept your

apology in due course in the chamber.Senator Herron—No, we won’t need to; I heard you clearly say that.Senator FORSHAW—Minister, you announced this scheme, you did it with a great deal

of fanfare, you clearly took particular ownership of this scheme and you saw it as a greatinitiative. You told us in parliament and you told the public what this was going to do. Youaccept all that. Senator Neal has asked you, and asked the officers, and out of the six

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communities where the pilot program is going to be run, you cannot tell us which ones haveactually started other than one, and I was saying to you that I find that quite incredible. Yourresponse was to say that you took account of the community attitudes. That is a totallydifferent issue to the state of your knowledge about your own program.

Senator Herron—What I said to you was that we will find out from the army where theyhave got feet on the ground. That is what you wanted, wasn’t it, Senator Neal?

Senator FORSHAW—We appreciate that, but we are wondering why you don’t know now.Surely the department is monitoring this?

Senator Herron—We will find out for you as soon as possible. If you like, I will go andring the army now, if it is your desire.

Senator FORSHAW—Isn’t it your desire, Minister, to know how the program isproceeding?

Senator Herron—I want to see the success of the outcome of the programs rather than doa bit of point-scoring at a quarter to six at night.

Senator FORSHAW—You raised it, not us. I started out this questioning by asking whenit was going to be completed, and you volunteered that you did not quite know when itactually started.

CHAIR —The offer has been made to find the information. Let us move on.

Senator Herron—The first program, as I said to you, was Oombulgurri, which came of anurgent request as a result of a cyclone. That was completed. So the army devoted all theirattention to that. That was an unexpected occurrence.

Senator FORSHAW—Yes.

Senator Herron—That was complete. The planning took a long time because we respectedthe cultural sensitivities of the communities, and it had to be the request of the communitiesafter discussion with the communities. As anybody knows when you are dealing withAborigines, particularly isolated communities, you have to sit down with them and discussthe pros and cons, and the process is enormously time-consuming. And that was as it occurred,and we respected that. So there was never any pressure put on any community to reach adecision. Now, having said that, the planning processes have been completed for those six.I will find out exactly for you, as you want to know, and I respect that. It is a matter of aphone call to the respective army office to ask where they are at the moment.

Senator NEAL—While you are making that phone call, Minister, could you also find outwhen it is planned on their work plan to complete each of those projects as well?

Senator Herron—If that is possible.

Senator NEAL—I am sure you won’t do it if it is not possible.

Senator Herron—No, the completion dates. They may not be known.

Senator NEAL—The other thing I would like to know is what funding was allocated tothe army to conduct these pilot programs. You don’t know that?

Senator Herron—Yes, I do know the answer. It came from the—

Senator NEAL—But do you know that? That question was not on notice. If you know theanswer, could you advise me now.

Senator Herron—Yes, we are going to.

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Ms Dunlop—The department of health contributed $5 million and there was $5 million fromthe ATSIC budget as well.

Senator NEAL—For what period of time was that?Ms Dunlop—It is for these specific projects. Part of the money was rolled over to this

financial year.Senator NEAL—So it was allocated originally last year, so 1996-97.Ms Dunlop—Yes.Senator NEAL—And how much of it was rolled over into this year?Ms Dunlop—The $5 million from our department was. I am not sure on ATSIC’s money.Senator NEAL—Sorry, I did not quite catch what you said.Ms Dunlop—The $5 million from the department of health was rolled over.Senator NEAL—What about the money from ATSIC?Ms Dunlop—I cannot tell you on that.Senator NEAL—So the entire funding provided by the department was rolled over from

last year to this year? And is it only provided for this year?Ms Dunlop—Yes. The funding is expected to be expended this financial year.Senator NEAL—If the money is not expended, unless it is rolled over, it is essentially gone,

is it?Ms Murnane—I am not sure that that is a useful line of questioning at this stage.Senator NEAL—It is useful for me; it may not be useful for you.Ms Murnane—We are just six weeks into the financial year. The nature of all capital works

is that you do have quite a lot of up-front time. The minister has described specific issues inrelation to remote Aboriginal communities. We do not expect that we will have to roll themoney over, but if we do, if the money is not spent, if for some reason we are not able todischarge the money in this financial year, then there are mechanisms that will allow us toroll the money over so that the programs will be completed.

Senator NEAL—That was not my question and, frankly, whether my line of questioningis useful to you is really unimportant. My question was: if the money is not rolled over, doesthe department or does this project lose the use of it at the end of the year?

Ms Murnane—I think I answered the question.Senator NEAL—No, you didn’t.Ms Murnane—I am resisting saying that if money is not spent and it is not rolled over,

it is lost.Senator NEAL—That is the truth, isn’t it? So why don’t you just give me that response?Ms Murnane—All I can say is that that is not in prospect.Senator NEAL—But that is what will occur, if it—CHAIR —This is very hypothetical, Senator Neal.Senator NEAL—It is not hypothetical.CHAIR —It is. It is totally and utterly hypothetical, and you cannot expect the officers to

answer hypothetical questions.Senator NEAL—We have already got the answer. It was resisted for 20 minutes—

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CHAIR —Excuse me, if you want to be rude, you can go outside and be rude. Ms Murnanehas already answered the question in the hypothetical—

Senator NEAL—Exactly; so why are you speaking about it?

CHAIR —So could we move on, please?

Senator FORSHAW—Could I just follow on? Do I take it from that answer you just gaveto Senator Neal that you anticipate that in each of the six communities the pilot project willbe finished within the current financial year and all the moneys expended?

Senator Herron—I certainly do. As I say, they are a pilot project. We want to then evaluatebecause there are many other aspects of it. There is training of the community andmaintenance. We want to evaluate it then to see whether it is a useful model.

Senator FORSHAW—I was going to ask you some questions about that.

Senator Herron—It may well be that we will roll that then into the HIP program.

Senator FORSHAW—All I can say in response to the exchange that just took place is thatthat was a question I asked about 15 minutes ago, which was: what is the anticipated timeframe in which this project will be completed?

Senator Herron—I said six months.

Senator FORSHAW—Yes, I know, and then we asked a question you did not know andnow we have got an answer that it is within the next 12 months. I have got the answer Iwanted—

Senator Herron—We wanted to give you a factual answer. It was not your question;Senator Neal wanted to know just exactly where it is at the moment, and we will find out foryou.

Senator FORSHAW—That is why we asked the question. The program, as we know, didnot get started really last year other than the planning. I accept all that. Then it is rolled overto this year. It is in this year’s budget and the funding is allocated for this year. If presumablyit is intended to try and complete that within this year, then it is relevant to ask what stagethe program is at in regard to each of the six communities, and that is the whole purpose ofwhat we are trying to do.

Senator Herron—I am not disputing that.

Senator FORSHAW—If we only got those answers half an hour ago, we would not havehad to continue.

CHAIR —Are there any further questions?

Senator Herron—I said to you half an hour ago we would find out for you.

Senator FORSHAW—You just told us.

Senator Herron—I think you should be applauding us.

[5.53 p.m.]

Program 4—Family and children’s services

Subprogram 4.1—Children’s services

Senator NEAL—I think I asked you this question last time, but I will try again: does thedepartment have information about fee increases over the last 12 months?

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Mr Wight —The information that we have indicates that, as at last September 1996, averagefees across the country were $152 per week of full-time care, that is, 50 hours a week. I havethe figures by state; it varies slightly, but it is around that $152.

Senator NEAL—That is at September 1996?Mr Wight —Yes.Senator NEAL—Do we have anything that would show what the change is?Mr Wight —Can I correct that? That is as at March 1997.Senator NEAL—What is the change between September and March?Ms Carmody—Probably the most readily available figure to me is the figure that was used

in the annual report last year, at the end of June, and that was $144 per week for full-timecare, 50 hours of care.

Senator NEAL—There has been no update since then? There are no other available figures?Mr Wight —No. At this very moment, though, the annual child-care census is being run

in all child-care services around the country. The bulk of the child-care census forms willprobably come in in a month and it will take a couple of months to get them entered into thecomputer system, so we may have more up-to-date information in three to four months.

Senator NEAL—In time for additional estimates?Mr Wight —I hope so.Senator NEAL—Apart from that census, does the department do anything else to monitor

child-care fees?Ms Carmody—There are regular data collections, and in the future there will be a more

systematic way of doing this. Under the current arrangements we monitor child-care fees ona quarterly basis, but it has a quarterly delay. It is taken from acquittal data that is collectedfor the preceding three-month period, using the child-care assistance system.

Senator NEAL—Is that separate from the census?Ms Carmody—Yes, it is.Senator NEAL—The census is done once a year?Ms Carmody—It used to be done every two years; this year it has changed to every year.Senator NEAL—When do you expect this new system that you are putting in place to start

running, and how will it improve the situation?Ms Carmody—There are two things happening. At the end of the October the parent

information line will begin to operate. That information line will include fee data on eachservice, and will be maintained by the operator that has won the tender on that job. In additionto that, the new Commonwealth Service Delivery Agency will have information on child-carefees which we will be able to access.

Mr Wight —The agency will have its data from the beginning of January.Senator NEAL—You said Internet, did you not?Ms Carmody—The parent information line.Senator NEAL—Is that the Internet, or is that the phone?Ms Carmody—No, there is a separate initiative involving the Internet which is about

providing better information to new operators of child-care services. That is to be launchedin the next couple of weeks. So there is a number of measures that will actually improve the

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level of information we have available to us, or that we are making available in the publicdomain.

Senator NEAL—The parent information line is just a telephone line, is it?Ms Carmody—It is a highly sophisticated telephone line, yes.Senator NEAL—It is like those computer voices, ‘Push one for this.’Ms Carmody—No, there will be a real person on the other end.Senator NEAL—A human being, that will be an interesting start. I think I asked you this

last time: with the changes that have been occurring in child care, are you keeping recordsof child-care centres that close down? On the last occasion there was an assertion, I think, thatthere were no child-care centres closing. Is that right?

Mr Wight —I do not recall the answer last time, but I think from memory that we hadfigures indicating that 12 centres had closed down between the end of September last year andwhen we were here at estimates last time.

Senator NEAL—I see.Mr Wight —The current situation is that there are 20 community-based services that have

closed down over the period from September last year. Most of those services that have closedwere in financial difficulties at about last September, and there are measures that are nowcausing them to finally close. Most of them have had some special one-off support in recentyears to maintain them as a service.

Senator NEAL—In relation to those 20 closures, can you tell me where they were, by state,and whether they were city or metropolitan? If you can give me the names of the centres Iwould appreciate it, but if there is some problem with that—

Mr Wight —I can tell you now, by state. There are two in New South Wales, eight inVictoria, four in South Australia, five in Western Australia and one in Tasmania.

Senator NEAL—Would you be able to give me the addresses or suburbs of them, onnotice?

Mr Wight —On notice, yes, we can do that.Senator NEAL—Did you make an assessment of how many families were affected by the

closures of those centres?Mr Wight —I do not believe we have done an assessment of the number of families.

However, the department has been involved in a number of the services—it may be all. I amcertainly aware that in a number of cases we have been involved in assisting families in theservices that have closed in finding appropriate child care in an alternative centre.

Senator NEAL—In what proportion of cases would you have assisted them?Mr Wight —I would have to take that on notice. I believe that our state offices have been

assisting in all cases, but I cannot be absolutely sure without a specific check.Senator NEAL—That being the case, I would be very interested to know whether the

children generally went into another accredited child-care centre, whether they went into someother form of child care, whether one parent stayed home or whether the child went intoinformal care. Would you have kept that?

Mr Wight —We certainly would not have that specific information. I doubt whether, as partof the process of assisting families, we would have kept that detail, but we might be able toget a general picture.

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Senator NEAL—I would appreciate it if you could. Have you got any mechanism in placeto ensure that children who leave the child-care centres and maybe go into informal care havea good quality care provided to them?

Mr Wight —No, we have no system in place that checks where children who leave child-care centres go to.

Senator NEAL—You have had a centre review process going on. I cannot remember theamount of money provided for the review of child-care centres, but it was quite substantial.

Mr Wight —The total over two years was $8.3 million to assist services adjust to the newarrangements.

Senator NEAL—Who actually conducts those reviews?

Mr Wight —The work that we required as part of those reviews was documented and madeavailable to anybody that wanted to carry out the work specified in the specification. Peoplewere asked to indicate to the department if they were prepared to carry out that work, and theirnames were then included on a list that was sent to all services. The services were then ableto select anybody who nominated to carry out the work to do the work for their centre, so itwas a selection by the centre from a list. If there was anybody who was not on the list thata centre was keen to utilise, they could then ask that person to nominate and they could beadded to the list.

Senator NEAL—Was there a person called Pru Worrilow from Families at Work on thatlist?

Mr Wight —I have been advised that we understand she may well have been.

Senator NEAL—When you prepared that list, what checks did you do on the people whovolunteered themselves, to ensure that they were suitable people to do a review in a child-carecentre?

Mr Wight —I may need to be corrected by one of my officers, but I understand we did nochecks. We just asked anybody to nominate that they were prepared to do the work and thenwe indicated the services that they could select from the list. I understand that some otherorganisations prepared advice that was given to services to assist services determine who theyshould select from the list and the sorts of issues that they should take into account in selectingfrom the list.

Senator NEAL—It is an issue that has been raised that these people are obviously operatingin child-care centres and they have indirect contact with children in many cases. It was raisedas a concern that these people might not be suitable people to be involved with children andthat no checks had been done. Is that a concern of the department?

Mr Wight —It would be a concern if somebody fell into the category that you weredescribing. The only answer that I can give at this stage is that we put responsibility back onthe service to make whatever checks they thought appropriate, in addition to those that weidentified, before selecting a consultant or an adviser.

Senator NEAL—Did you let the child-care centres know that you had not made any checksas to whether they were suitable and it was up to them?

Mr Wight —We did not do any vetting whatsoever, but we provided information on the listof the qualifications and background of the people who were on the list. That was against theirname on the list. Through a telephone hotline that we contracted out, there was advice

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available to all services to assist them to determine the selection of the appropriate adviseror consultant.

Senator NEAL—So there was not a warning saying, ‘We have not checked these peoplefor suitability; make your own checks’?

Mr Wight —I am advised there was a specific warning saying that the department had notchecked those people.

Senator WEST—How clearly? Where was it written?Mr Wight —It is in the register of names that were sent to all services.Senator NEAL—Do you have a copy of that, or can you provide it to us?Mr Wight —Yes, we can provide a copy. I do not have a copy with me.Senator WEST—This was raised with me by someone who had been to a briefing or

seminar put on by the department. It was not until she as a police officer asked the question,‘Were any safety or security checks done on these advisers?’, because she was concerned aboutpaedophilia, that she was told, ‘No, there are no checks.’ It was not apparent to her as someonewho scrutinises these things for this particular issue fairly closely that there was an adequatewarning for the centres to know that they had to go and do their own security checks onadvisers. That raises the question as to how an organisation would go and do a security checkon an adviser.

Mr Wight —The only comment that I can make is that the warning is in the document thatwent out to all services. If it was not highlighted by our departmental staff in a briefing, thenI can apologise for that. But if my advice is correct, when we provide a copy we will highlightwhere it is in the register that I am referring to.

Senator WEST—As well as advising them that they are responsible for doing the checks,do you advise them as to how they go about doing checks?

Mr Wight —I am not sure whether you are talking about a general check about the qualityof their work or—

Senator WEST—There is the quality of their work, but there is also the issue—which isa bit topical, these days, in a couple of states—of whether these people are actually knownpaedophiles. What is to stop a known paedophile registering as an adviser?

Mr Wight —There was no mechanism to stop what you just described as a knownpaedophile registering as an adviser. There was advice provided to services about how theyshould check out the credentials and particularly the ability of the advisers to provide theadvice that was outlined in the specification. That is the only process that was put in place.

Ms Murnane—I think we should clarify the situation. These are not people who would beexpected to have direct contact with children. In relation to people who have direct contactwith children, and have been convicted, the department and the minister, together with thestates and territories, have developed protocols to allow that sort of exchange of information,where it is possible. We have assisted child-care services with that. These advisers would bein the nature of an accountant or an auditor coming into a service-

Senator WEST—That is not true. They will be visiting the child-care centres where childrenare.

Ms Murnane—Yes, as other workers would be.Senator WEST—That is the concern.

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Ms Murnane—Unfortunately, with paedophilia, we are in a situation where we have to beincredibly careful, and where all organisations that run services for children have to beincredibly careful. The point I am making is that we are not talking about a worker who, dayin and day out, has direct contact with children. We are talking about somebody who comesinto a centre for a short time for the purpose of reviewing business arrangements and providingadvice on that.

It is certainly a situation in which care is needed and that is why the department took thesteps that it did. But it is not a situation that warrants the same sort of care as if those peoplewere being employed to care for and assist with the development of children on a daily basis.

Senator NEAL—I do not agree and I do not think many parents would either.Senator WEST—When was warning given to the centres that they would have to do the

checking?Mr Wight —It was at the time the register was sent to all services indicating to them the

work that had to be carried out and the list of approved consultants to carry out that work.Basically, it was from day one, when they got their list of people who had nominated to dothat work. It was in that register.

To reinforce what Ms Murnane said, while I accept that the people carrying out the advicewould have to go into the centre, the main objective was to work with staff in identifying theirstaffing arrangements, their accounting systems and to provide advice on where savings oroffsets could be made to minimise any fee increases. There was not any involvementwhatsoever with the programs that were being conducted in the centre or the services.

Senator NEAL—How many centres have already had reviews undertaken?Mr Wight —I am not able to give you the number that have been undertaken or completed

or are in progress. We only become aware of work when it is completed and we have receivedthe final account, signed and approved, as the work being acceptable to the service. We havereceived 160 of those completed reports.

Senator NEAL—As of today?Mr Wight —Yes, as at when we put this information aside for this briefing over the last

couple of days.Senator NEAL—Well done! You are a lot more up to date than most people. From those

reviews that you have seen, I am interested in knowing the total loss of staff contained in therecommendations of all those reviews, any reductions in staff conditions, the number ofrecommendations for increased fees, and any recommendations that relate to increasing, in anon-financial sense, the contribution of parents, whether it suggests that they clean, gardenor things like that.

Mr Wight —That would be an extremely difficult task because the advisers are providinga broad range of advice to services about how they can modify their service to reduce anyincrease in fees. I am certainly aware that a large number of them have suggested that oneavenue would be to reduce the number of staff in a centre where the current levels of staffare higher than that required by state government recommendations. There appears to be quitea number of services that are staffed at a higher level. But, with respect to increasing fees andso forth, I do not believe that there will be any recommendations which pick up that point ofview.

Senator NEAL—They actually have, because I have spoken to centres where it has beenrecommended that they put up their fees.

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Mr Wight —Then, in fact, if that is the case, it is not intended as part of the reviews,because the purpose of the reviews is to identify options for services, whereby they can reducecosts rather than pass on the loss of operational subsidy to parents through increased fees.

Senator NEAL—From the report to a particular child-care centre that I discussed, itappeared that the person doing the review thought the purpose was to make their expenditureequal their income, which seemed fairly logical.

Mr Wight —Sorry, but I must say that my previous answer needs correcting, in thosecircumstances. In some cases where an adviser came in and advised a service that their servicewas currently not running on a break-even basis, then I could understand that an independentreview of that service might say that the only way it could survive would in fact be to increaseits fees. I would certainly have to accept that, in those circumstances, there may be adviceabout increasing fees.

Senator NEAL—One other matter I was interested in, in terms of the reviews, was whetherthere where recommendations to reduce hours of the centre.

Mr Wight —I would have to take that on notice.

Senator NEAL—Yes, along with all those other things. I understand it will not be a simpleprocess, but all I want to know is whether, out of 160 reviews that were done, there were 20recommendations to reduce hours, 20 to do this, 30 to do that, and so on, in very generalcumulative terms rather than in detail.

Mr Wight —Senator, I am being advised that the process that we planned to go through isto take a reasonable size of sample and to continue updating that sample as more come in.So, if you take on board that we are already planning to do something similar to what yourequested on a sample, I doubt that we will do it for every report, as it would be very timeconsuming.

Senator NEAL—Okay. If you could indicate what the size of the sample is, it would beappreciated.

Mr Wight —Yes.

Senator NEAL—There seems to be an indication that some 20 centres have closed. Is thereany forecast by the department about further closures in the future?

Mr Wight —No. As I said, our expectation in implementing this measure was that therewould not be closures. We believe that services would adjust fees and the services that theyprovided in order to offset the loss of operational subsidy. However, as I have already pointedout, 20 services have closed, and there may be others. But all of those were in some difficultiesbefore the decision, and I certainly would not want you to misinterpret what I am saying bythinking that the 20 services closed as a result of the budget measures.

Senator NEAL—I understand what you are saying; but, by the same token, I think thereis some logical connection. It may be that they were not running perfectly well commerciallybeforehand, but I am certain that the changes that occurred would have adversely affected themand may have tipped them over the edge, although I accept that they may not have been thesole contributing factor.

Mr Wight —Right.

Senator NEAL—How much is the Commonwealth expected to save as a result of theclosure of those 20 child-care centres?

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Mr Wight —I do not believe that the Commonwealth will save any funds out of thoseclosures, because the intention would be for those places that are closed to be reallocated andtherefore filled by children elsewhere around the country. I accept that there might be sometransition time in that, which could lead to some small reduction in outlays.

Senator NEAL—We have now got this ration of 7,000 places; so, from the 20 centres thatclosed, how many child-care places would there have been?

Mr Wight —In round figures, I guess we would say 800. They have 40, on average.

Senator NEAL—Say 800. Does that mean you are increasing the ration, so that in the firstyear you are allowed 7,800 new places?

Mr Wight —In effect, yes. We have always, when community based services have closedin the past, reallocated those places to other services if they were interested in them and wereprepared to take them, and that will continue. The difficulty that that will cause is that thecapital has already been provided for those places. Yes, there will be 800 new places available,but there is not a budget allocation of capital to build new community based centres to providethose. However, they could be added on to existing services that have the capacity to take onadditional places.

Senator NEAL—Or a private sector one that just wanted to put in the capital itself?

Mr Wight —Possibly, but I believe we would go through the first option, as we always havein the past, of offering those places to the community-based centres as add-on places.

Senator NEAL—When those child-care centres close down, do you actually send out a letterto community based centres in the area, saying, ‘A centre has closed down, and we have gota few places available for distribution: would you like some of them?’ Is that how the processworks?

Mr Wight —I would have to take on notice the actual process we go through. I believe that,in the past, our state departments have known of services that have been looking for additionalplaces, and so have made a straight offer to them, rather than canvassing around to find outwho might want extra places.

Senator NEAL—Can you take on notice, for those 20 centres, whether they have foundother replacement places for them in each case?

Mr Wight —For the children or for the vacant places?

Senator NEAL—For the replacement places.

Ms Carmody—I do not think we would have, at this stage. There is the transitional process.Our first priority is to attempt to find a new sponsor to take over the facility. It might be thatanother sponsor might be able to still make that service survive for service in that area, andthat is our first priority. But, in the event that we cannot get a sponsor to take over thatfacility, we then attempt to allocate them within the area and then, if there are no takers withinthat area, we go state-wide. With these services having closed only fairly recently, I wouldbe surprised if any of them have been reallocated.

Senator NEAL—You can take that on notice. You are doing me a list of closed centres;so, if they have not got to that stage, just indicate that on the list. If they have, you canconfirm that they have transferred the places. We talked on the last occasion about rationingof the 7,000 places each year, and we discussed how the department was going to work outwhat the priority areas were. Has that process occurred yet for the priority areas?

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Mr Wight —No; the identification of the high needs or priority areas has not yet occurred.The first step in that process has been to establish planning committees in each state, involvingrepresentatives from the various sectors, Commonwealth government and state government.Those planning committees are in the process of being set up at this very moment. Theexpectation and the time frame that we are working to is to have those committees identifythe high-needs areas in first priority for the 7,000 private sector places, by the end of October,with a view to publishing that information in order to give private operators a little lead timeto think about their interest in those areas before seeking approval for those places from 1January onwards.

Senator NEAL—So they can apply as from 1 January?

Mr Wight —January 1 is the date that the limit starts to apply. Anything that is up andrunning before 1 January automatically gets approved, because there is no limit at this moment.

Senator NEAL—So, they have got until October. If they want to do it post 1 January, theyhave basically got two months in which to apply and get approval.

Ms Carmody—The information will be available on the high need areas to investmentnetworks, new operators and so forth, from October on. That information will be advertisedin newspapers, and they can then apply to set up services in those areas. But the high-needareas remain almost like a standing indication that those areas need care, until they are satisfiedby approvals. The approval system against the 7,000 will only take place for services thatbecome operational after 1 January. For example, if an area is identified as needing 100 child-care places, we will update the Internet site and distribute information to the industry on aregular basis. The Internet site will be updated weekly to reflect the approvals that are madein that week. If an area is approved for 100 and only 50 have been approved in that area, theInternet site figure will then be reduced to 50.

Senator NEAL—You say that in the high-need areas the places will remain open, but forhow long? For the whole year?

Mr Wight —Until they are satisfied. Each area will be identified with a number of placesand, once that number of places is satisfied, I think we will probably do—and I emphasise‘probably’—some sort of review part way through the year to identify the areas that have beensatisfied and those that are not satisfied, so that we can then list the next lot on the list in orderof priority, if there are some in the initial release that are not satisfied because nobody wantsto take them up. We do not want to finish at the end of the year without allocating the 7,000places, so we may well go through a mid-year process of identifying some new areas.

Senator NEAL—That was exactly my concern. If you leave the places open all year andno-one wants to take them up, and you come to the end of the year and you have used maybehalf the places, that seems a bit of a waste.

Mr Wight —That is true. The process is not absolutely finalised, but our intention is to doa review part way through, to monitor what has been taken up and what has not, and then toextend the advertised list.

Ms Carmody—The planning committee process involves a six-monthly review. That willreview the relative ranking of areas, because demographics will change. If a major employergoes into an area or whatever, its need for care will need to be included in the assessmentprocess. So, those reassessments will again be advertised and the Internet site updated.

Senator NEAL—That is all I have on long day care.

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CHAIR —Could I just seek some advice from senators, please, as to how much more youbelieve you have on Family and Children’s Services? It is worth allowing the officers to gohome prior to dinner, or do you want to call the officers back after dinner?

Senator NEAL—I will probably be another half an hour or so on child care and anotherhalf hour on family resources. I have some questions—while we are doing this housekeeping—on the community support service scheme, but I think that might be in program 7.

Ms Murnane—Yes, it is, Senator.

Senator NEAL—I have some questions in that area as well—which, again, should take lessthan half an hour.

Senator DENMAN—I have about four follow-up questions about questions I asked lasttime.

CHAIR —We will bring the officers back after dinner.

Sitting suspended from 6.27 p.m. to 7.35 p.m.CHAIR —Let us resume.

Senator NEAL—Something has been brought to my attention that I would like to clarify.I asked about Pru Worrilow and I raised it in close proximity to a range of questions aboutthe unsuitability of some people to deal with children. No inference should be drawn fromthat that she was in one of those classes of people, and I hope that that inference was notdrawn. The reason I asked it was that, in theAustralian Financial Reviewon 21 May 1997,an article referred to some statements made by her to the effect that parents who usecommunity based child-care are already cutting back on their hours in anticipation of fee riseslikely to be between $5 and $15 per week and that, meanwhile, families are turning to informalcare or reducing their working hours to cope.

Bearing in mind that she is one of the people who seems to have been approved as a reviewingperson, does the minister agree that that is the situation?

Mr Wight —I certainly had no evidence to indicate that that is the case. We have someanecdotal information but nothing, as I have said in answer to earlier questions, in terms ofan organised collection that some services are increasing fees in the range that you havementioned. However, we do not have any evidence about people cutting back on hours as aresult of those changes, nor of people reducing their working arrangements to cope with thosechanges.

As you would be well aware, there is a range of factors for why people might be changingtheir working habits. In fact, for some time now, ABS surveys have been showing thepreference of many women who are participating in the work force to work part time; andthere have been increasing percentages of women with children working part time, while therehas been a steady, consistent level of work force participation by all women. There is no datathat we have available to us that indicates the latter part of your question, which was thatpeople are actually cutting back on hours so that they can cope and that the child-care changesin the budget are generating those changes.

Senator NEAL—I might ask you the question in reverse: do you have any information orevidence that shows that that is not the case?

Mr Wight —The only answer I can give is the same as I gave before. We do not have anyinformation or any data on the case that you specified. I am advised that that sort ofinformation will be collected in the census by the ABS.

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Senator NEAL—But they would not collect information about why people are leaving longday care, would they?

Mr Wight —No.Senator NEAL—I have some questions that I will put on notice; they will be provided to

you later. There has been debate on the Child Care Payments Bill which is coming up. I wouldlike to know whether, in the lead-up to the preparation of that bill, there has been anyindication to child-care centres that their previous child-care funding agreements will be nulland void.

Ms Murnane—I am sorry, Senator, but Mr Wight was saying something to me in relationto the debate in the Senate—which, of course, has not occurred yet. Would you mind repeatingthe question?

Senator NEAL—My understanding of the bill is that it has the effect of making contractsfor funding of child care null and void: is that correct?

Mr Wight —It is not quite so, Senator. Under the bill that is before the parliament—andwhich I was raising with Ms Murnane as to how far we can go in debating that bill in thisforum—there is provision for a requirement that all services enter into new contracts with thegovernment. The reasons for them having to enter into new contracts with the government arethese.

Firstly, it is to ensure that the number of approved places in each centre is actually lockedin to each new agreement; and that is not the case with all of the existing agreements. Brieflythat is because, in 1997-98, the government have that 7,000 limit on new places. We wantto be able to ensure that services that have got the physical capacity to increase their places—that is, the building has already been built to take 60 or 70 places, but they are only operatingat 40—if they want additional places, have to come in and claim them under the 7,000 limit.The first point is that the new agreement has to cover the number of places that we haveactually approved for them.

Secondly, and probably an equal or a more important reason why a new contract is required,the new bill contains a number of provisions that are not in the existing legislation. Forexample, appeal provisions against decisions by the government are not provided for in thecurrent agreement. So there are a number of positive benefits to services that come in the newact, and they have to be signed, through an agreement, under the new act—if and when itpasses the parliament.

Senator NEAL—Putting aside for a moment the potential advantages of the newagreements, is it correct that the effect of the bill is to make null and void the old agreements?

Mr McRae—I will have to answer this carefully, because I am not really sure, but I thinkI can take it on a little. I do not think it does, but that may not be correct. I am sorry, but Iam relatively new in this game. We are bringing forward a transitional bill in conjunction withthe bill which is before the parliament now. That transitional bill will provide the opportunityto deem the current agreements valid for as long as we need until new agreements with allthe centres are in place, and so there will be no problems in that context.

Senator NEAL—It seems to me to be a logical step, if you are requiring people to enterinto new agreements, that you cannot have two agreements running at the same time. It musthave the effect of making the existing agreements null and void.

Mr Wight —I think that has been answered by Mr McRae. Basically, what we will do ifwe do not have the opportunity or the time between the passage of the bill and its coming into

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effect on 1 January, we will deem all of the current operators as approved under the new act.The answer to your question is that that is correct: it will invalidate all of the previousagreements but it will not affect the actual operators, because until they sign an agreement—Ibelieve Mr McRae’s earlier answer is correct—they can be deemed to be approved under thenew legislation.

Senator NEAL—They ‘can’ be, or they ‘will’ be?

Mr Wight —They can be, but they will only be if we do not have the time to actually havethem sign new agreements.

Senator NEAL—Has the department advised the child-care centres as to the effect of thebill making the agreements invalid?

Ms Murnane—There are transitional arrangements. In effect, from the point of view of theoperation of the centres and the actual operators of the centres, there will be no change. Thetransitional arrangements will come into play and will deem the current agreements to be lawuntil they are changed.

Senator NEAL—They can be; it does not necessarily mean—

Ms Murnane—The intention is. I think that there are a few grammatical niceties going onhere, if I might say. What Mr Wight was saying was we can do it if we need to. Let me saythat if we need to we will do it, so that no centre is in danger of their agreement beingdeclared null and void and not being covered by the transitional arrangements.

Senator NEAL—You do not really seem to understand the concern. You are assuming thatthe department is acting in the interests of both themselves and the child-care centres. A lotof child-care centres have a negotiated agreement. They may be happy to negotiate a newagreement or they may not. But by having this legislation have the effect of making previousagreements null and void, basically they are forced to. They have got a gun at their head whenthey are negotiating the new agreement. If they say, ‘I don’t agree with the provisions of thenew agreement’, the department says, ‘You’ve got no agreement. If you don’t agree with thisnew one, you’ve got nothing because this legislation has the effect of making our oldagreement void.’ In those circumstances, it is a concern for child-care centres and probablysomething they should be aware of, I would have thought.

I understand that the transitional provisions give the department the power to carry it overif they choose, but what if the department does not choose? What if the department says,‘Look, we’ve given you the option of going to a new agreement. You haven’t agreed with usabout the terms of it and you have not taken it up. But you don’t have the opportunity ofrelying on the old agreement.’

Ms Murnane—It is usual when you are actually changing the operating basis throughlegislation to have transitional or savings legislation to cover you over an interim period.

Senator NEAL—I understand that.

Ms Murnane—That is what this is. We are going to check tonight—now if we can—whether or not technically the Child Care Payments Bill 1997does have the effect that youdescribed of rendering the current agreements null and void. If it does, it is purely a technicalthing, but we are going to check if that is technically correct.

Senator NEAL—It is not a technical thing. You do not seem to understand my question.It basically puts child-care centres at a disadvantage in terms of negotiating a new agreement,because they have nothing left they can fall back on.

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Mr Wight —I can understand that you are saying that the legislation will render the existingagreements null and void. The details and the guidelines for a service participating in thearrangements to get child-care assistance are all specified in guidelines under the new bill, sowe will have things in the new bill that cover the requirements that are currently covered byan agreement. You use the words, ‘It will declare the agreements null and void’. In somerespects, I believe that is true. But coming back to the deeming: any deeming will actuallyhappen if it has to happen and that depends on whether or not we have the time in thedepartment to have every service complete an application form and sign a new agreement. Ifwe do not have the time between the passage of the bill and 1 January, there will be a deemingby document so—

Senator NEAL—I understand the transitional provisions.

Mr Wight —The point I was trying to make was that the deeming will be certain. It willbe done well in advance of 1 January. Services will all know that they are deemed under theagreement for a specified period to be an approved service and therefore will continue to haveeligibility for child-care assistance under the new act.

Senator NEAL—I understand the transitional provisions and I understand that there willnot necessarily be a child-care centre left without an agreement at all. What if the child-carecentre says,‘Look, I don’t want the new agreement. The provisions are less advantageous forme than the previous agreement. Therefore, I do not want the new agreement.’ You areassuming that the child-care centres will quite happily enter into the new agreements that youare proposing. To me, if I were a child-care centre being told I would be going to get lessunder the new agreement, I would probably prefer to stick with the old agreement.

Mr Wight —Senator, I do not think that is an option. If the bill passes the parliament,services that want to continue to be eligible for child-care assistance under the new act willhave to meet the requirements of the new act and so they will have to agree to sign that newagreement.

Senator NEAL—That is exactly the point I am making. They do not have a choice. WhatI would like to know is what are the consequences that flow from that? Does a child-carecentre with an agreement under the previous arrangements, which are now cancelled as it wereby this legislation, have a right to come back and say, ‘I am going to recover from theCommonwealth my loss of revenue under this new agreement’? And secondly, could they then,if they do not wish to sign the second agreement because they do not believe they arefinancially viable under the new agreement, sue the Commonwealth for the failure of theirbusiness?

Mr Wight —Senator, I cannot answer that question. I will have to take that on notice andget legal advice.

Senator NEAL—Thank for that; I appreciate it. I have got some other questions that relateto South Australia. Apparently there was a direction on 26 June 1997 in South Australia onchanges to child-care assistance payment services, which took effect obviously before this billwas carried. Are you aware of it?

Mr Wight —I do not understand the advice that you are suggesting.

Senator NEAL—Sorry, I will restate it. I was a bit clumsy. Apparently on 26 June 1997,the department directed within South Australia that the new child-care assistance should comeinto effect. Child-care assistance was cut for the October-December quarter to 90 per cent ofthe April-June claim.

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Mr Wight —Senator, I am not aware of the specific letter that you refer to, but I believethat letter was to ensure that there was not a large number of recoveries of excess paymentsby the department. Under the present arrangements we provide advances to the services forchild care assistance. We have an acquittal and a recovery from services at the end of thefollowing quarter. When we move across to the new agency, we will be making paymentsdirectly to services but on behalf of individual families. I am aware that some states arereducing the final payment to services. However, if services use that full final payment andneed additional funds because of the level of child-care assistance in that particular month orin the last quarter, then they can get a daily turnaround from our department in additionalfunds. The whole intention is to minimise the recoveries of overpayments in the last quarterof this financial year.

Senator NEAL—Strictly speaking, can the department, off its own bat, decide to reducethe amount of payment in reliance on the assumption that this legislation will be passed, beforeit is actually passed?

Mr Wight —Sorry, the payments that are made to services are advances based on thedepartment’s estimate of what a service will need. I guess we have always in the past beena little bit liberal in going over what the department assesses that they need because it waseasier for services to have a small excess and for us to adjust it in the next quarter. Becausethere will not be an adjustment in the next quarter, they would all have to be by recoveries.It is basically risk management of the taxpayers’ funds in the last quarter of the presentarrangements. But it is all based on the department’s estimate of what a service will need inthe quarter.

Senator NEAL—Okay. You have said that it is going to be a requirement that all child-carecentres reapply for child-care assistance. Have all child-care centres been advised of this?

Mr Wight —Yes, they will be advised and they will be required to fill out an applicationform under the new act once it is passed. But we cannot advise them until the legislation goesthrough the parliament.

Senator NEAL—It is going to take effect as of 1 January, is it?Mr Wight —The new arrangements take effect from 1 January but because the bill is before

the parliament, subject to passage of the legislation, we will be advising them of thearrangements as soon as possible after the passage of the legislation.

Senator NEAL—You said that there will be transitional arrangements. Putting that asidefor a moment, does the department expect that they will be able to substantially enter into newagreements with most child-care centres, or will the major proportion be left in the transition?

Mr Wight —Yes, we hope that they will all be able to sign new agreements. The uncertaintyis whether or not there will be any delays in the passage of the legislation.

Senator NEAL—Because, if it in the House of Representatives now, it will go to the Senate,but I think there are about 30 bills in front of it. I do not know if the government will chooseto expedite it but, assuming they put it in virtually immediately, you are looking at probablyanother two weeks.

Mr Wight —We believe that we can complete the process as long as it is through by mid-October.

Senator NEAL—What happens if it is not through by mid-October?Mr Wight —We will have to wait until it does go through, and then we might have to move

into that deeming option that we discussed earlier.

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Senator DENMAN—I have some questions in reference to questions I put on notice lasttime. The first one is question 152. The question was this: have all Tasmanian long-day centrescompleted their restructuring plans, and the answer was no.

Mr Wight —I think that would still be the case.

Senator DENMAN—It is.

Mr Wight —I am advised that we have not paid for them. Whether or not they have actuallyfinished them and not submitted final accounts to us we cannot be sure of, but we have notpaid for all of the grants. As I said in answer to an earlier question, we do not pay them untilwe receive a copy of the final report.

Senator DENMAN—So do you follow up? Do you give them a limited time?

Mr Wight —No.

Senator DENMAN—Question 153: have all Tasmanian centres demonstrated their ongoingviability? And I guess that is no, too, again; you do not know because of the other—

Mr Wight —Yes. We still do not know that answer.

Senator DENMAN—Question 154: what Tasmanian centres took advantage of therestructuring grants and what were the requisite amounts provided to each centre in Tasmania?

Mr Wight —Again, we do not know that information.

Senator DENMAN—How long will it be before you do know?

Mr Wight —Senator, we only have that information on a progressive basis. As I have said,as they complete the reports, it is entirely up to them to take up the offer of funding to engagean adviser. They do that. We do not know about it until we see the final report. I did say thatthere was no time limit on those reports coming in. I probably should have said ‘The end of1997-98’, because the funding that was provided for restructuring grants is only provided fortwo years. So we would only be able to pay bills that come in in two years.

Senator DENMAN—Question 158: what is the expected private growth in Tasmania forthe 1997-98 financial year? It was not known. Is that known now?

Mr Wight —No, it is not. The number of places that will be allocated to Tasmania willdepend on the planning committees that currently are being established in each state, and thenthey will make their assessment of needs and identify the areas in each state where there ishighest need for child-care places. They are just commencing their work. In fact, the planningcommittees are just being established.

Senator DENMAN—Question 337: I remember that one of the big problems with the rebateused to be that you had to get the signature of both parents on the form. That was referringto this child-care stuff here. What I wanted to know was whether that was still going to bethe requirement, and the response was yes. But do you have any problems getting bothsignatures?

Mr Wight —As to the first part of your question, it is still a requirement under the newlegislation that both signatures are required, and I am not aware of problems that we have ingetting both people to sign.

Senator DENMAN—My concern was where there are split marriages and those sorts ofthings. That is what I was intending to ask about that.

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Mr Wight —I am advised that there are provisions in place that seek to take account of thatsituation that you described as an example, but I am not aware of particular problems thatindividuals have in providing the information.

Senator DENMAN—Thank you. That is all.Senator NEAL—Is it true that the transitional bill that is being drafted to go along with

this bill deems any long day-care centre that is presently operating as approved?Mr McRae—What the transitional bill does is provide the opportunity for I think it is the

secretary to deem any operating centres as continuing to be approved for the duration that hespecifies.

Mr Wight —He does not actually deem them. The bill actually contains provision for themto be deemed. The transition bill itself will not deem them.

Senator NEAL—So long as they are already approved or so long as they are just operating?Mr Wight —So long as they are already approved and operating.Mr McRae—It is a continuation of approval that we are talking about.Senator NEAL—So if a centre is not approved now, will it have any effect?Ms Carmody—If it is approved by the end of December, it will be approved in January.Senator NEAL—But if it is not approved?Mr Wight —It has got to be approved and operational by the last day in December to be

able to come in as eligible under the new arrangements.Senator NEAL—Before- and after-school care has seen lots of changes with the abolition

of the operational subsidy, and there has been a lot of concern expressed to me byorganisations that run those centres about what the effects of these changes will be. You mighthave seen a media release put out by NOSHER on 14 May 1997 where they say that thechairperson, Robert Munro Miller, stated that while an increased number of families willreceive child-care assistance, the removal of operational subsidy will result in an averageweekly shortfall of $14.50 per child. Is that a statement that you agree with?

Mr Wight —If there is a loss, it is $14.50 per approved place, as distinct from child.Senator NEAL—I suppose I mean per child. Sorry, what do you mean by—Ms Carmody—A child is not typically in outside school-hours care every day of the week

traditionally. The data indicates that—Senator NEAL—So you are talking about a full-week child?Ms Carmody—Yes.Mr Wight —So we believe the amount of around $14.50—we would not disagree—is the

amount they will lose for an operational subsidy for a particular place over a week. But thatplace might be used by two or three children, which is why I questioned it when you said$14.50 per child.

Senator NEAL—That is correct.Mr Wight —Senator, can I just add that to make up the $14.50, that is also based on five

hours per day. I said five days a week, but it is five hours per day, which is normally the totaltime for two hours before school and three hours after school. There are very few childrenthat are in the full five hours. It is virtually a worst-case scenario, with most children onlybeing in after school. That is the total amount that they would lose from operational—

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Senator NEAL—It may be unusual as a statistical average, but there are some areas whereit is very common, particularly in areas like where I come from, the central coast of NewSouth Wales, where parents often commute. There are also other areas on the fringe ofSydney—Liverpool and Campbelltown. Those sorts of hours are very common these days,although probably Australia-wide it is not so common.

Mr Wight —The figures that you mentioned are based on 25 hours per week and there arecertainly some services that operate that long. The average usage is around 15 hours a week.

Senator NEAL—There has been some concern expressed by people operating before andafter school centres that there has not been a lot of consultation with them about the changesthat are taking place. In particular, there is correspondence from the Central Coast CommunityCouncil, which is the peak body for before and after school care centres on the central coast.I will put a number of matters to you and I would appreciate your comments on them. It says:As far as we are aware, there have been no consultations with service providers, parents and thecommunity regarding the implementation of the new system.

Can you comment on that?Mr Wight —Your said ‘implementation’, and that is probably a reasonable comment on the

basis that the budget has not been down that long and we have been starting to talk withorganisations about implementation. Part of the difficulty is how far you go before the passageof the legislation, but we have certainly had correspondence sent to all services. Every servicehas had some letter about what is happening.

I would want to make a brief comment on the level of consultation that took place in thedevelopment of the system as distinct from implementation because as you probably are wellaware, the particular option that is being endorsed in the budget was one of several optionsthat was part of a pilot funded by the previous government for two years trial. There was alot of supporting research and a lot of consultation which involved parents, all the peakassociations and a number of services. I think 2,000 places and 70 services around the countrywere involved in that pilot.

In terms of research, consultation and negotiation with the community in developing theproposal that is now before parliament in legislation, from my experience in the program,which is now several years, it is probably the most consultation that has ever taken place inthe development of a reform initiative.

Senator NEAL—In the development that may well be the case.Mr Wight —In implementation, and I go back to my first comment on implementation. Since

the budget we have contacted all services and described the new system. But in terms oflocking in arrangements and detailed arrangements about how that will work, we are limiteduntil the passage of the legislation because it is part of the new bill.

Senator NEAL—But it is meant to come into effect at the beginning of the new year.Mr Wight —Yes.Senator NEAL—It is very close. The concern is understandable because the services

basically will have to start operating the system from the new year. A lot of these services,before and after school care, close down during the long Christmas break. It means that theyhave only got until mid-December to put all this in place. They are becoming a bit nervousabout it all.

Mr Wight —The issue that we spent some time discussing earlier was with regard to grantsthat were available to services and organisations for long day care centres that were losing

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operational subsidies. Similar grants are available to outside school hours care services andwe are at the moment developing a list of consultants that they may be able to use to get theiradvice about how they may look at their business and operate under the new service. Theyhave been given information about those grants and there has been information sessions inmost states, but not all yet.

Senator NEAL—Will that be available to every centre?Mr Wight —Yes, every centre.Mr McRae—There is actually a short guide to the new arrangements, which will probably

be circulated next week, and which goes to all services of all styles.Senator NEAL—When that comes out, I would like a copy as well. Another thing that the

Central Coast Community Council have stated is that $5.8 million has been spent on pilotprograms, but that services have been unable to obtain the research pertaining to theseprograms.

Ms Carmody—A summary of the research has been released and sent to all outside schoolhours care services and to the services that participated in the pilot. The two years of researchcomes up to a good 12 inches of paper, and for that reason we summarised it.

Senator NEAL—It says ‘have been unable’, and this is not just one centre, this is a bodythat represents a dozen or so. It seems rather peculiar that they have been unable to obtainthe research.

Ms Carmody—There is one request with us at the moment for access to the full researchreport.

Mr Wight —Certainly they have all got the summary report, and obviously that can beprovided now; but this has been mentioned. One service has sought all of the information, butnot of us.

Senator NEAL—Which service is that?Ms Carmody—We have a request from Network New South Wales.Senator NEAL—That is not these people. I would appreciate it if you would contact them

as ask them what research they need, and if you could provide it to them; because it does seema bit wasteful if money has been spent on research that they cannot get the benefit of.

Ms Carmody—We will need to have the details.Mr Wight —If you provide us their address and a contact, and we will follow that up.Senator NEAL—I think Judi Moylan has already received this letter. This is just a copy

of a letter sent to her, but I will give you a copy before we finish tonight. It says thatrepresentatives from the department have held information sessions in many areas, but areunable to answer many questions and do not have the ability to clarify information.

Mr Wight —The only answer that I could give is that I am surprised. They should be ableto. As part of following up the research information, I will take on board that we will ask themwhat sorts of questions they have been asking and move to give them responses to thosequestions.

Senator NEAL—One thing they particularly raised is the whole vexed issue of maintainingquality control in before and after school care. They are very strongly of the opinion—anopinion that I agree with—that there should be some monitoring of the quality of before andafter school care. I was wondering if the department has any plans to put in place a mechanismto do that.

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Mr Wight —The government is concerned about the quality of care in family day care andin outside school hours care, on the basis that they are two service types that do not have aquality assurance system in the same way that long day care centres have. The governmentmade a commitment in the lead-up to the last election that they would move to implementquality assurance systems in both of those service types.

The minister has recently approved funding of the National Family Day Care Council tocommence some basic research on a system for family day care, and consideration is currentlybeing given to a similar sort of exercise with respect to outside school hours care services.I should also say that state governments also agreed, a year or so ago, that they would lookat national basic standards for inclusion in state government regulations for family day careand outside school hours care.

Senator NEAL—What is the rough timetable for that issue to be resolved?

Mr Wight —I am not sure that I can put a timetable on that. The issue of how to progressit is currently being considered in the department, and then it will depend on the minister’sagreement to a course of action. A course of action has been started, as I said, in family daycare, and it is being considered how to progress the outside school hours care commitment.

Senator NEAL—So it is basically in the hands of the minister at this stage.

Mr Wight —When we develop a formal proposal it will be. We have not put a suggestedproposal to her as yet, so it is between the department and the minister.

Subprogram 4.2—Family services

Senator NEAL—Going back to the questions that were asked last time and paraphrasing,the proposal was to transfer half the funding from the family resource centres after they closeddown to a program which would provide family support services at youth activity centres. Howfar has that process gone? When is it proposed that the family resources centres will close?Has an offer been put to the youth activity centres?

Mr Wight —With respect to the question regarding when the family resource centres arelikely to close, funding will terminate from the end of December. Some services, dependingon outstanding commitments that they have got, may well close a little earlier than that, butthere will be no ongoing funding beyond 1 January.

With respect to the offer to youth activity services, the offer has not yet been made to allyouth activity services. However, an offer will be made in the very near future to all of theyouth activity services around Australia to enable them to engage a part-time support workerto work with families in their areas with adolescent children.

Senator NEAL—Just before I go on and talk about the youth activity centres, is there anyproposal at all to keep some of the family resource centres open?

Mr Wight —No.

Senator NEAL—In particular—I would just like to get this on the record—the centres atCairns and Alice Springs?

Mr Wight —No.

Senator NEAL—Okay, that is very clear. You might remember that last time we talkedabout the provision of a family support worker within youth activity centres, we talked aboutwhat the budget per centre could be. The figure we got down to, if I recall correctly, was$14,000 per youth activity centre. Is that correct?

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Mr Wight —No, it is not. As I recall the figure that we calculated at the time, it was$22,000. We have always been thinking around $20,000, and that is why I would not haveraised any concerns when we previously discussed $22,000. We think the offer to each servicewill be around $20,000 to $22,000.

Senator NEAL—Last time we attempted to do a budget on the run, which failed fairlymiserably, and I do not think I have received anything since then. Have you worked out abudget?

Mr Wight —No, we have not. The intention is that each service will be offered $20,000 toemploy a family support worker, as I said, to work with families with adolescent children.

Senator NEAL—I did not think that was the original proposal at all.Mr Wight —The original proposal is that where we are funding youth activity services,

which are services targeted at adolescent youth, there is to be a worker to work with thefamilies of adolescent youth in the areas. That is in the 90-plus areas where youth activityservices currently exist.

Senator NEAL—That is the first time I have ever heard it said that they were supportworkers to work with families with adolescent children. I do not recall that term ‘adolescent’.

Mr Wight —That might be my generalisation of children between about 11 and 18 or 19.Senator NEAL—I might go back to have a look at the budget portfolio document.Mr Wight —It is the same target group as for the youth activity services, which we have

always talked about being available for youth aged between 11 and 16.Senator NEAL—I just do not remember ever seeing it honed down to that precision. I do

not think it was set out in the portfolio document. It is a refinement that probably is wise inthe circumstances, but I do not think it was necessarily ever in there that it was restricted tofamilies with adolescent children.

Mr Wight —It was certainly the intention. That is why the original concept was linking itwith the youth activity services and making the offer to provide additional support for familiesand youth that were using the youth activity services. An answer has just been pointed outto me which was given at the last Senate estimates and which does actually use that term, butit was not in answer to a question of yours.

Senator NEAL—Was it?Mr Wight —It was an answer to a question from Senator Gibbs.Senator NEAL—I know I tried to make this point last time. I really would like to ask you

to take on notice and work out what can be purchased with $20,000 to $22,000, because I havea real concern that that sum of money is so small in the circumstances as to really be useless,or worse than useless in that it is an expenditure of $22,000 that really does not get youanything. The process of working out a budget might be useful in illustrating that. I thoughtyou had taken it on notice last time, though I do not remember you precisely saying that. Ijust thought that was going to occur. Could you actually do that this time?

Mr Wight —It would be extremely difficult to do any work in that area because I think—andit is a personal assessment—that each youth activity service may well respond differently asto how they use those funds and in many areas there may well be either their own agency oragencies providing family support in the area where they will pay them this amount of moneyto extend slightly the services that they currently provide, so that it is seen as funding inaddition to what other support might be available in the area. In that sense, it could be all used

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on providing services to families; in other instances, I can imagine that there will be someoverheads that will eat into it.

Senator NEAL—Most youth activity centres are really just either an old building or a hall,teenagers are there, and there is normally an adult who gives some sort of fairly loosesupervision. But it is not really a set-up which I would have thought would be easily translatedinto a—

Mr Wight —I do not visualise that they would necessarily work in the centre. The offer willbe for the sponsor body of the youth activity service to be a sponsoring body for theseworkers. If they are not set up in such a way that it is appropriate for them to be thesponsoring body for the additional worker, then we see that they may well negotiate with somesponsor that is providing a similar service in the area. That is why the way that it is actuallyput into effect by the different youth activity services around the country may well vary. Untilwe get out negotiating with them, and talk with them about what options they would preferto support their area, I do not think we can be too definite or too precise about how thesefunds will be used.

Senator NEAL—How many youth activity centres do you believe will take up your offer?Mr Wight —I would hope the whole 90 to 95, whatever is the exact number. Whether or

not they actually do it themselves, or whether they direct that assistance to other sponsoringorganisations that can support their activities in the area, I am not sure, but I would certainlyhope that they would all take up the offer.

Senator NEAL—If you do not get 95 per cent of them accepting the offer, would youconsider that a disappointment?

Mr Wight —Yes I would. But the other option would be that if some services do not takeit up and it can be usefully used in other areas, I think we will be putting proposals to theminister that any amount that is not taken up is directed towards other areas. It would be inthe same 95 areas, but where additional support can be provided to families in the other areas.

Senator NEAL—Are you aware of any local government bodies or councils that arepresently carrying out the functions of a family resources centre?

Mr Wight —No I am not.Senator NEAL—Did you want to check with Ms Grigson?Mr Wight —I do not believe that we would have access to that information. We do not go

out and seek information about who is providing advice to community groups around thecountry or supporting community organisations in their area. So I do not see that we wouldhave any access to that information, nor do I believe anybody would.

Senator NEAL—But wouldn’t it be useful? There is some view with the closure of thefamily resources centres—and I think it was put to us last time by Senator Newman—that therole performed by family resources centres was no longer necessary. Isn’t whether there areother bodies providing the service of some relevance to that?

Mr Wight —I do not believe that that is what Senator Newman said.Senator NEAL—I was paraphrasing.Mr Wight —I believe that what she was saying was that there are 11 areas of Australia that

have the support and assistance of a family resources centre in coordinating and assistingservices in their area, but there is a very large number of areas in the rest of Australia thatdo not have that support and that in those areas it is probably carried out in a range of different

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ways. Services getting together in some cases probably is assisted by local government, butin a much less structured way.

Senator NEAL—There were some comments made by Minister Moylan that there werelocal government bodies doing the same function as family resources centres. Could you takemy question on notice and advise me which local government bodies are doing that?

Mr Wight —I will have to take that on notice, because I am not aware of any.Senator NEAL—That is fine. I do not have any further questions. Thank you for that.CHAIR —We will now move to program 5.Ms Murnane—Madam Chair, before we go to program 5 there was a question from Senator

Neal that I would like to provide a little bit of clarification for. It was with respect to the ChildCare Payments Bill. Senator, this would be subject to further advice tomorrow but we havebeen through the bill and it does not appear that this bill actually touches the currentagreements. Certainly I can find nothing in the bill, and neither can my advisers here, thatactually makes the point that the current agreements are null and void.

This bill is a bill to change the law and what it does then is set up new arrangements thatwould become law if the bill became law. Until those new arrangements can be put into place,there is no threat to existing services implicit in the bill in any way. We will deal with thatthrough a transitional arrangements bill that will carry them until administratively we are ableto catch up.

Senator NEAL—Thank you for your answer. I will look forward to a firm statement aboutthat tomorrow.[8.28 p.m.]

Program 5—Aged and community careSubprogram 5.1—Community care and support for carers

Senator FORSHAW—My question on 5.1 is one which I am positive you will want to takeon notice. Could the department please supply a breakdown of the costs to users of HACCservices by service type and by state?

Mr Conway—Yes, we will take that on notice.Senator FORSHAW—Thank you very much.Senator GIBBS—In the June estimates, my question 102 was: how much was spent on

dementia care last year? The reply was $6.134 million for 1995-96. Obviously, that is the case.This year, $1.5 million is being spent, so that means $4.5 million less is being spent thisfinancial year. What programs have suffered from this huge loss?

Ms Bryant—Senator, could you clarify the question for me?Senator GIBBS—In the budget it says this year, 1997-98, the targeted support for people

with dementia and their carers is $1.5 million. I asked a question on how much was spent ondementia care in 1995-96 because I did not have those figures. The answer was $6.134 million.I might be wrong but if we only to spend $1.5 million in 1997-98 and we spent $6.134 millionin 1995-96, that is a huge decrease in spending this financial year from last financial year. Bymy figures it is about $4.5 million less, so obviously there are a lot of programs that are goingto be a little bit deficient there.

Ms Bryant—I will take that question on notice, if I may. The explanation lies in the factthat the national action plan for dementia care, which was a five-year program, finished as

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at 30 June 1997 and the activities under that were winding down and so on. I think that iswhere the explanation lies, but I will take that on notice and give you a more detailedresponse.

Senator GIBBS—Okay. That previous figure of $6.134 million was for 1995-96 and thenthis is supposed to be for 1997-98.

Ms Bryant—We will give you a more detailed response.

CHAIR —Any other questions on subprogram 5.4?

Senator FORSHAW—I have questions on subprogram 5.3.

CHAIR —I do not have anything listed that you had advised for 5.3.

Senator FORSHAW—If you have a look, Chair, it says ‘Senator Forshaw—allsubprograms’.

CHAIR —I am sorry, subprogram 5.3 then.

Subprogram 5.3—Residential access and quality

Senator FORSHAW—There have been some questions placed on notice by Senator Mackaywith respect to the closure of Derwent House Nursing Home in Hobart, which I am sure youwill get. I understand Senator Denman may have some questions on notice on the same issue.We are just checking to see that there is no duplication, if you like.

I will turn to some general questions. Firstly, on nursing homes, aged care, et cetera, is thereany evidence that nursing homes are delaying the entry of permanent residents until after 1October when entry fees accommodation bonds can be charged?

Ms Bryant—As far as we are aware, there is no evidence. When we look at occupancy datafor nursing homes, there is no evidence of any decline in occupancy. We also think that it isunlikely that it would be the case in any instance because the amount that a facility wouldforego in terms of the Commonwealth subsidies is such that it would not be economic for themto be deferring until after 1 October. That would be a greater loss to them than the likely gainin waiting with empty places until after October.

Senator FORSHAW—You are obviously monitoring the situation because the view thatthat could happen has been expressed. If it was too happen it is more likely to happen in thefor-profit sector rather than the not-for-profit sector.

Ms Bryant—Nonetheless, as I have said, it does not look like it.

Senator FORSHAW—We will probably revisit it later in the year to see just what hashappened. Could the department supply national figures on the number of permanent residentsentering nursing homes in each of the calendar months of 1997 to date? Would you mindproviding those on notice? Could you also give similar figures for rent for people enteringfor respite care, as well? Thank you.

Senator WEST—Of those going into nursing homes, how many would be in theconcessional resident category? What are the waiting periods? How long have they been onwaiting lists? Have, in fact, those who are in the concessional category been on waiting listslonger than those who are not in the concessional category? Maybe you can answer that now.

Ms Bryant—Senator, it would be very difficult to give you any accurate information onthat because with nursing homes under the current arrangements we have a flat fee paid by

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everyone and consequently we do not record in any way their status as concessional or non-concessional. We certainly do in hostels but we do not currently do it for nursing homes.

Senator WEST—Can I have the same information for hostels as well, please? Can you tellme now whether the waiting periods for admission to hostels for concessionals and non-concessionals is different?

Ms Bryant—Right. The available evidence that we have from some research done over thelast couple of years suggests that people who are financially disadvantaged do not wait anylonger. We can get you the more particular details of those research projects and their findings.

Senator WEST—I find that difficult to believe because when I talked to ACAT teams inrural New South Wales they told me that people who are concessional or financiallydisadvantaged are waiting longer. They are using more respite care for the care of thosepatients until they can get a permanent bed in a hostel than people who are not concessionals,who are full fee paying.

Ms Bryant—We will get you the evidence and the available information that we have. Iam certain there would probably be anecdotes to the contrary in some locations but we have—

Senator WEST—I would have classified talking to the leader of the ACATs—they can tellyou the number of people they have and the length of time they are waiting—as a bit morethan anecdotal.

CHAIR —Settle down, Senator West.Ms Bryant—We will provide you with the research information that we have to hand on

that subject.Senator WEST—To your knowledge, no information on this is collected from the ACATs,

who are the people who are responsible for giving the classification levels and the ticks orthe crosses for people to be admitted to hostels and nursing homes?

Ms Bryant—The information that ACATs hold on waiting times for people varies acrossstates. Certainly, Tasmania has some data. There is beginning to be some data available fromQueensland. In other states the data is much more patchy. We can give you waiting times fornursing home and hostel residents. It is not consistently recorded by financially disadvantagedor other status and most of our evidence in that area comes from particular research projects,which we will have to give you as specific pieces of information.

Senator WEST—How is the legislation going to be monitored to ensure that there are nodelays for those people who are financially disadvantaged?

Ms Bryant—Another point that may be relevant here is that we know that the number offinancially disadvantaged people accommodated in hostels currently is well in excess of themandated requirements. But, as I say, the data is limited in this area.

Senator WEST—If it is well in excess of the mandated requirements, I would be interestedto know the percentage.

Senator FORSHAW—Can you detail the steps that the department has taken to informnursing home staff, ACATs, general practitioners and other persons or groups that clearly havean interest in the issue of the new arrangements to take effect on 1 October?

Ms Bryant—We have an extensive information program which we have under way. Fornursing homes, hostels, basically the provider organisations, we have produced several kitsof information. We released a kit publicly, for example, in February and in May. We arecurrently undertaking extensive training sessions in all states and so on and issuing training

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manuals, et cetera, to those people. For broader consumer people in the community et cetera,we deliver to them the kits on requests that we have made available generally. We have aninformation hotline that people can access which is widely advertised in the media et cetera.We are producing a number of specific products for consumers—documents such asCarechoices, A user’s guide to the system, questions people might be wise to ask when they areseeking to enter residential care et cetera. So there is a variety of products for that group.

Aged care assessment teams are again on our mailing lists for all the information kits thatwe produce. There is training to start this month that will be targeted to the ACATsspecifically to meet their needs and there will be a nationwide program of training for thoseorganisations. We have also met extensively with the state governments who work with us,obviously, on the assessment program, have identified the needs and plan to meet them forthose groups.

For GPs and others in the community, again we are having a broadly based strategy thatlooks at particular products that need to be made available, as GPs are points of contact forconsumers and so on—the types of information consumers will need and the products we needto supply to groups such as GPs, assessment teams and others as part of a broad informationstrategy.

Senator FORSHAW—Could we be provided with samples of those kits? It would be veryuseful to be able to have a look at the type of information that is being disseminated. Couldyou do that?

Ms Bryant—Yes; samples of the information products, certainly.Senator FORSHAW—What do you intend to do in situations where nursing homes, because

they have not studied the information or participated in the training or they do not understandthe new arrangements, fail to implement the new arrangements, assuming that it all kicks offon 1 October or some other date? Do you have a contingency plan?

Ms Bryant—I am trying to imagine what aspects of the arrangements they might not beimplementing. Certainly the majority of the organisations to date have applied for certificationso are partaking in that process. The majority of them have an interest in bond charging andare well aware of things on that front but, if they elected not to charge bonds as a managementdecision, either driven by ignorance or a matter of policy on the part of the organisation, thenthat is within their discretion anyway.

Because the Department of Social Security and the Department of Veterans’ Affairsundertake the income testing and we make the adjustments to subsidies and so on, those factorsare within the department’s control in terms of implementing them in any case. In terms ofoutcomes standards and accreditation, those organisations are already obliged to comply withstandards and, if they were failing to meet their existing and new obligations in that regard,the department would be clearly taking very definite action with them to address thoseproblems.

Senator FORSHAW—I notice that you said at the start of your answer that you found ithard to understand how they may not be able to comply. All of the areas you mentioned areones where I can envisage nursing homes, for one reason or another, not being up to speedand having everything in place on the date of commencement. I know Senator West willshortly ask some questions about certification, but the principles have yet to be finalised, Iunderstand. They are being circulated. The draft set was out last time. There is the prudentialarrangements, and we will come to questions about that, I am sure, soon. There is theaccreditation, as you mentioned.

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The message that I am getting loud and clear from talking to people involved in themanagement, to people who are making inquiries in nursing homes and who have contactedus and to associations about what particular nursing homes are going to do in respect ofcharging bonds, how much and so on—and I do not think this is just anecdotal—is that it isjust a mass of change that nursing homes feel very uncomfortable about in terms of being ableto cope with it all and be ready in time for the date.

I concede some other places may be ready—particularly new homes, where the nursing homemay be part of a multipurpose centre with a hostel and self-care units. Under our government,we funded construction of quite a number of those. They might be geared up a bit better. Ican assure you that there are a lot of places out there that do not feel confident that they aregoing to be ready on that date. What is the position of the government? Do you still expectto be able to commence on 1 October with all of these changes?

Ms Bryant—Certainly the government intends the arrangements to commence on 1 October.I can appreciate that, if you had comments from the industry some weeks back, people mayhave had less confidence in their readiness and their knowledge base to implement thearrangements from 1 October. But certainly the feedback we have had from the extensivetraining program that has taken place in the last month suggests that people have found thecontent and quality of the information that they have been provided with through that traininghas addressed any perceived gaps in their knowledge that they may have had. Certainly theevaluation results from that suggest that the very large majority of them are now feelingconfident that they understand the arrangements in detail.

Senator FORSHAW—I think there is also an attitude that people just have to cope withthe change anyway. They expect that if they have to do it they will do it. But I can assure youthat I am still hearing concerns. Only time will tell on that I suppose. Senator West I knowhas some questions on certification.

Senator WEST—Before homes can charge accommodation bonds they will have toundertake certification; is that correct?

Ms Bryant—That is correct.Senator WEST—And that will have to be done every three years or is it accreditation that

is going to be done every three years and that is different?Ms Bryant—Accreditation is every three years, and it is different from the certification

process, yes.Senator WEST—How many nursing homes and hostels are there in Australia?Ms Bryant—In total, around 3,000 facilities.Senator WEST—How is the certification being undertaken?Ms Bryant—I might hand that question to my colleague, Senator.Ms Yapp—What we are doing at present is that we have contracted out to building and

engineering experts to actually undertake the certification process. There has been aninstrument developed in consultation with industry. To ensure that providers can be certifiedas close as possible to 1 October homes are actually being inspected during this period againstthe assessment instrument that is being developed. So at this stage—

Senator WEST—So those assessment instruments have been finalised?Ms Yapp—Yes, in terms of the building quality.Senator WEST—Do we have a copy of those?

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Ms Yapp—No, you will not have a copy.

Senator WEST—I would like a copy, please. How many people are there on thecertification panel?

Ms Yapp—It is not a panel. You mean—

Senator WEST—Someone is doing inspections you said?

Ms Yapp—The person making the decision is ultimately a delegate of the secretary. Indeciding whether or not to certify, they take into consideration the results, amongst otherthings, how they are doing with care and so on and the quality of the building. I am not surehow many inspectors there are, but I think there are around about 30.

Senator WEST—And all of the homes are being inspected?

Ms Yapp—Yes, unless they have opted out. But the vast majority are being inspected.

Senator WEST—How many are still to seek certification? How many of the 3,000-odd havenot lodged or sought applications for certification?

Ms Yapp—I think almost all have indicated that they would like to be certified and ofthose—

Senator WEST—There is a difference between indicating they would like to be certified.Have they actually undertaken any process—

Ms Murnane—Senator, we will take that on notice.

Senator WEST—Okay. Now there is 3,000 to be done in less than three months. That is1,000 a month.

Ms Bryant—We have completed over 1,000 to date, Senator. The remaining ones weanticipate will be completed before 1 October.

Senator WEST—I am trying to find out how many nursing homes there are and how manypeople are doing the certifications. It strikes me that unless you have a very large team outthere doing the certifications you have no hope in Hades of getting 3,000 certificationscompleted by 1 October. Presumably, a number of these will be failing and will have to bere-done and will want to be re-done by 1 October.

Ms Bryant—It is progressing as expected that all 3,000 will be inspected before 1 October.They were well under way when, for example, at one stage it looked like we had a 1 July startdate. At that stage we certainly were not going to be able to get the full 3,000 done then, butthere is certainly—

Senator WEST—Who are the consultants undertaking this process?

Ms Bryant—Fisher Stewart.

Senator WEST—How were they selected?

Ms Bryant—What happened was that last year we placed advertisements in nationalnewspapers calling for expressions of interest. We received 22. We assessed those against arange of assessment criteria, including the ability to get the job done within the tight timeframes we had. On the basis of the 22 expressions of interest, we selected 17 in terms ofinviting them to tender. Fourteen then applied and a number of those were short listed andinterviewed. The selection panel included some people from industry and consumer groupsin terms of selecting those consultants as the ones who were best able to get the job done.

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Senator WEST—How many have failed to meet the requirements to date? If there has been1,000 done, how many have failed to meet the requirements and are going to have to be re-done before the 1 October?

Ms Yapp—We are looking at the first 1,013 facilities, which are the ones we have data onto date. If we look only at the building quality, this does not consider the other sorts of issueswhich will also be considered, like their care standards, whether or not they meet statelicensing requirements or whether they have major risks that for other reasons we could notcertify.

Senator WEST—Does that include fire standards or not?

Ms Yapp—Yes, it does.

Senator WEST—So includes compliance with the individual state fire regulations?

Ms Yapp—That is right.

Senator WEST—So which of the state regulations does it not include?

Ms Yapp—Part of the consideration for certification is that some states have broaderlicensing requirements for residential facilities. So where we have evidence that that is notbeing met, then certification will not be approved.

Senator WEST—Can you give me details of what those state requirements are that haveto be met? I do not care if it is state by state, but I do want them, and what state requirementsdo not have to be met.

Ms Yapp—Okay.

Senator WEST—You still have not told me how many failed the first time.

Ms Yapp—In terms of the first 1,013, the indications that there are 186 facilities that donot meet the set level of building standards. That equals about 18.4 per cent of facilities thathave been inspected to date.

Senator WEST—It represents that size in facilities. How many beds does it represent insize?

Ms Yapp—I am sorry. I do not have the break-up by beds, just by facilities.

Senator WEST—Can I have it in a break-up by beds and does it appear to be more in onestate? Are there clusters or what is the situation?

Ms Yapp—I would need to take that on notice and let you know.

Senator WEST—You do not have that?

Ms Yapp—Not here, I am sorry. What I can tell you is that that percentage is higher thanwhat we are expecting overall, primarily because we targeted high risk homes in the initialstages when we were aiming for a 1 July start date. The first 600 homes that were inspectedwere regarded, from the limited knowledge we had, as possibly high risk in terms of notmeeting certification requirements.

Senator WEST—I would be interested to know what criteria you used to isolate those 600as the high risk ones?

Ms Yapp—Yes. We can provide that on notice.

Senator WEST—Of the 186 that have failed, have they had a second chance and have infact some of them already passed?

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Ms Bryant—They can apply to be re-inspected. So they can re-apply for certification whenthey feel they have addressed the issues that had been identified as causing them to fail. Tomy knowledge we do not yet have such applications from people, but when we do we willcertainly institute the process of re-inspection.

Senator WEST—So there has not been any change to the certification criteria andguidelines?

Ms Bryant—The instrument has a number of guidelines and we have had concerns raisedby the industry. The department met with them in recent weeks and did agree a number ofmodifications to the scoring, that is, the way the instrument was scored against particularquestions, but those have all been agreed in consultation with the industry. We can give youmore detail about where those scoring changes were on the instrument.

Senator WEST—I would like that, and since this modification has taken place, what hasbeen the failure rate?

Ms Bryant—With the change to the way scoring is done, it means that we now have torevisit the inspections that had already been completed—the first 1,000—rescore them againstthe new agreed scoring base and then advise them again of what their revised score is. NowI expect that will result in some change to the number of 186 that I gave you. In fact, it willbe a reduction in the number of failures, but we have not yet got the revised figures.

Senator WEST—Probably after they have been redone, they will not have failed?Ms Bryant—A proportion of them will still fail. With some their scores may marginally

increase to put them above the pass mark. So we would expect that that number of 186 failuresin the first 1,013 would be reduced.

Senator WEST—What were the modifications? Where were the areas of modification thatwere agreed upon?

Ms Bryant—There were in relation to a number of quite specific questions. The questionswere: question three, which related to toilets; question five, which relates to heating andcooling; question six, which relates to lighting and ventilation; and question eight, whichrelates to residential issues. They were the main areas of change.

Senator WEST—Now these instruments were initially agreed to in the committee, whichincluded not only the industry but consumers and the like.

Ms Bryant—That is correct.Senator WEST—The modifications were agreed to. Who was involved in that consultation?Ms Yapp—All of the steering committee were invited, which included a range of industry

and consumers. But unfortunately only some industry representatives were able to make thatmeeting.

Senator WEST—Oh dear! How much notice was everybody given of the meeting?Ms Yapp—I am not sure. I think it was about three days.Senator WEST—And why were none of the consumer groups able to attend and what has

been the reaction of the consumer groups?Ms Yapp—We advised the consumer groups immediately after the outcome of the meeting

and asked for views in terms of what was arrived at, but we have not received any views thatthey had any concerns.

Senator FORSHAW—Did the three days include a weekend?

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Senator WEST—That is the next question. Could you put dates on it? I will take the dateson notice.

Ms Yapp—I will give you firm dates.Senator WEST—And can I have a list of what the membership of that committee should

be and who was actually present for the decision to modify that? It would appear to bebasically just the industry groups without any consumers and presumably without any unionrepresentation or any groups like that. The guidelines have been changed. They have beenrelaxed and I wonder what this does to the standards. As far as accreditation goes, do we haveany instrument yet that has agreed on that?

Mr King —The accreditation will be based on how services are assessed against a range offactors. The dominant factor is a set of standards which are now in draft form and have beenfor some months. They have been extensively consulted with a variety of groups, consumersand service providers. They cover the range of factors now covered by the standards and arange of factors relating to management issues as well. Other factors we wish to consider ingiving the accreditation will be the building quality and we will use the same building standardwhich was used for the certification.

Senator WEST—The changed building standard or the original?Mr King —It will be based on the one which we now have. It may well be improved and

changed in various ways by the time we get into the accreditation process. One of the thingsto be settled there is what the pass score for accreditation is. I think at this stage it certainlywould be no lower than certification and might be higher, but that needs to be settled.

The other factors we wish to look at are: are services meeting their concessional residentratio requirement? If they had not met that for a number of quarters, that may be a factorwhich would mean that you do not give accreditation. Another one is: are they adhering tothe prudential requirements properly? Again, if there is evidence that they are not, that wouldbe a factor for not giving someone accreditation. Those two are fairly much yes or no typequestions.

Another area to look at will be facilities’ adherence to the various user rights consumerprotection requirements under the act and the way in which they are applying those. Part ofthat comes from information received from complaints, how advocacy services and othersreport back upon that service and an audit of the standards, looking at the issues and the wayin which services are interacting with their residents. Those are the range of factors we arenow looking at in the accreditation decision.

Senator WEST—But the instrument has not been decided upon yet?Mr King —In terms of an instrument, there is not an instrument on which you just give a

score to someone. It is a much more qualitative decision: overall, how does this place standup against the requirements we are after? More positively on that score, can we acknowledgethat some places are doing very well? We would be able to give recognition for that, as wellas just giving a pass mark. Part of the change is to try to give that recognition to those whoare doing well.

Senator WEST—When will we know what this is finally going to be?Mr King —The system is to start from next January. As you have mentioned earlier, services

have the following three years to get to that point. As I said earlier, the standards which arethe main part of that are in draft form but they are very near final draft form. We are preparingthe guidelines to go with them. When we have got the whole package together, the minister

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will be in a position to have a serious look at that and make a final decision on the package.That should be something which should be known, I would think, by the end of the next twomonths.

Senator WEST—You talked about groups that were involved in consultation. Are thererepresentatives of the Royal College of Nursing, Australia, or the New South Wales Collegeof Nursing on any of the consultative groups?

Mr King —In terms of this area we have Geriaction members, many of whom I think overlapwith those groups, and they were chosen as being a professional nursing group with an interestin aged care specifically, rather than going for the broader college groups. In terms of theactual consultations of a broader nature on the standards, I would have to check and confirmthat. I would think that there were members from some of those groups who attended thosebut I would have to check that, so I will take that bit on notice.

Senator WEST—You cannot tell me if the Royal College of Nursing, Australia, or the NewSouth Wales College of Nursing, the two organisations which are the principal and primestandard setters for nursing quality care and nursing training, nursing professionalism in thiscountry, have actually had a role in looking at some of these standards, particularly as theyapply to nursing, the nursing care and the health care?

Ms Bryant—At least one of those groups is represented on a group that we have workingon the documentation and accountability manual, so it is a working group set up to outlinehow facilities should document care plans, professional nursing practice and care practices thatshould apply in nursing homes and hostels, and they are part of that group. I can get you thenames of those individuals.

Senator WEST—I would appreciate that because I am wanting to make sure that it isactually the colleges and not the unions, because they are two entirely different animals. Iknow that the nurses unions are a bit unusual in some people’s eyes for a union, in that theyare also concerned about the quality of care that their members give, and the training that theyget.

Ms Bryant—I think that we in fact have both the unions and the colleges, but I will getyou the names of the whole membership of that committee.

Senator WEST—I would appreciate that. When it is all bedded down, is there only goingto be one committee left to be the sole supervisor and consultative mechanism for furtherimplementation and further changes, or are all the other committees that are currently inexistence going to remain?

Ms Bryant—Some of the committees have a natural life, in that they have been set up forspecific tasks. What consultative processes exist in the future is an open question that has notyet been determined. You would be aware from the bill being debated in the Senate, forexample, that there are commitments to review processes and so on which may involve newor different bodies; so it is a bit more open for the future.

Senator WEST—So at this stage we do not know if there are going to be one, two, threeor even zero committees left at the end of it, or what the representation will actually be onthose.

Ms Bryant—There is a commitment to ongoing consultation and there is a commitmentto continuing to involve providers, consumers, unions and so on in those processes; butwhether it is one committee, two committees et cetera is an open question.

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Senator WEST—This is where you worry me. You say ‘providers, consumers and unions’,but there are one or two groups that are not providers, consumers or unions. They are actuallythe professional bodies checking on the professional standards and having an interest in that.I want to register my concern about that.

Ms Murnane—Yes, Senator, and that point is well taken. The minister did appoint anadvisory body to look at issues in work force issues for older people, and the college ofnursing is represented on that body.

Senator WEST—Which one, the royal college or the New South Wales college?Ms Murnane—The Royal College of Nursing—the one based here in Canberra. The

Professor of Gerontic Nursing at La Trobe University is also on that body.Senator GIBBS—Further on accreditation, what happens if you get a nursing home or aged

care home that charges the patients the accommodation bond and then cannot meet theaccreditation? What happens: do they pack up shop and rack off with the patients’ money?What safeguards are going to be put in place to stop them making a fast buck?

Ms Bryant—In order to commence charging bonds from 1 October, a facility has to passcertification. As we have discussed earlier, that involves both meeting a building standard anda standard on the quality of care delivery. Although they have three years to obtainaccreditation, they are obliged from the commencement of the arrangements to be covered byprudential arrangements; so their residents’ monies paid in the form of a bond are requiredto be protected from the outset. They may be protected either under the general scheme orunder what the legislation refers to as specific prudential arrangements. The minister hasannounced her intentions in that regard, and residents’ monies will be 100 per cent guaranteedso that residents can receive their money back in full and within the requirement repaymentperiod in the event that someone loses their certification or accreditation.

Senator FORSHAW—That is a lead-in to the questions I wanted to ask about prudentialarrangements. The prudential arrangements were recently announced by the minister and, asI understand it, funds are to be allocated to a central pool. Is that correct?

Ms Bryant—It is broadly correct, yes.Senator FORSHAW—Where will this be located and who will manage it?Ms Bryant—The pool that you are talking about will be what is referred to under the

legislation as the general prudential arrangements. As for who will manage it, the structureenvisaged for this body is that there will be a board which manages it and there will be ascheme manager. For the scheme manager we have gone to tender to 14 organisations. Theyare broadly the very large accounting firms and banks. We expect that the successful tendererwill be from that field, or perhaps a consortium of a mortgage manager and a major accountanttype firm.

There will be a trustee appointed. Again that will go to tender to the major trustee-type firmsthat are already operating. There will be a funds manager and a scheme auditor. The actuallocation of the fund is still open. It in part depends where the successful tenderer is able tobase their operation. We would expect in a major capital city, but it will depend on the basethat exists with the successful tenderer.

Senator FORSHAW—And if a nursing home or hostel wants to access the fund, could youexplain briefly what process is involved there? They presumably put in an application andspecifications on what they want to use the funds for and it goes before the board of trustees.What is the broad outline of how they go about that?

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Ms Bryant—The fund operates so that facilities which charge bonds are required to place100 per cent of any lump sum that they receive into the industry fund, the trust. Once it isin the trust the provider is entitled to income from it. They are entitled to the retention amount,which is up to a maximum of $2,600 per year. So they will receive a monthly payment ofaround $217 as the retention income.

Senator FORSHAW—That is the draw-down amount over five years?Ms Bryant—That is the draw-down amount. So they will receive that as monthly income.

They will also be entitled to the income earnings on the invested lump sum, and that will bepaid to them approximately quarterly.

Senator FORSHAW—So it is an automatic reimbursement by payments by instalments?Ms Bryant—Yes. So they will have a hopefully constant, predictable income stream that

is being paid to them on a regular basis.Senator FORSHAW—Is there provision for them to leave the money in the fund rather

than have all this sort of book work if for some reason they did not actually want the incomecoming in on that basis? I cannot imagine them not wanting to.

Ms Bryant—It is not one we have explored, Senator, but, if anyone has an interest, I amsure it is one we can put to the scheme manager as to the scope for that, but it is not one Ihave an answer on now.

Senator FORSHAW—It is just what is running through my mind. I probably have to thinkthrough further about whether it makes any difference in terms of the investment earnings,but presumably that is determined by the overall earnings of the fund. It is very similar to amaster trust in a super fund, isn’t it, to that extent?

Ms Bryant—Yes, it will be a large fund and consequently have a good earnings capacity.Senator FORSHAW—Did the government or department discuss the structure of these

arrangements with operators before they were announced?Ms Bryant—The department held extensive consultations. We discussed the broad shape

of the prudential arrangements in the succession of what we called the funding and other issuesworking group. The consultants who were employed to develop the prudential arrangementsalso held a number of focus group sessions exploring these issues with individual groups ofproviders and consumers and so on. So, as part of their development of the arrangements, theyconsulted extensively. As to the detailed structure in terms of the scheme manager, the designof the trust deeds, et cetera, those pieces of information as they are developed by Attorneys-General and the other members of the team developing the prudential arrangements are beingprogressively brought to the committee as they are available for them to have a look at in moredetail.

Senator FORSHAW—I think in an earlier answer you covered this but, just so I have gotit clear, has any decision been made yet about who will administer the accommodation bondfund? I think you said earlier there is a tender process and that is to be decided; is that it?

Ms Bryant—No, the structure that we envisage is fairly clear. The successful tenderer hasnot been chosen. Tenders in fact close at the end of this month.

Senator FORSHAW—Were those companies or groups who are tendering approached orwas it an open tender?

Ms Bryant—It was a selective tender based on the advice that we had from the teamdeveloping the arrangements of who were most likely to have the ability to administer a fund

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of this nature and size. We went to 14 organisations. All 14 were subsequently invited to abriefing session to give them more detail and respond to any queries they had in developingtheir tenders. As I said, they are due to close at the end of the month.

Senator FORSHAW—I suppose you are not able to tell me who they are at this point intime?

Ms Bryant—Broadly, as I said before, they are major accounting firms and banks.

Senator FORSHAW—I understand the confidentiality, but in due course it would be helpfulif you could provide us with a list of the tenderers.

Senator WEST—Who was the team working on the—

Ms Bryant—The team is coordinated by a company called Oakvale Financial Advisers. Thelegal advice is a group from the Attorney-General’s Department, together with Kadir Brothers.We have had tax and accounting advice from Arthur Andersen and we have had actuarialadvice from Trowbridge.

Senator WEST—How were those groups all selected?

Ms Bryant—The principal coordinator of the team was again a selective tender to a limitednumber of organisations. The legal members of the team were a selective tender of aroundhalf a dozen legal firms and Arthur Andersen and Trowbridge were members of the teamappointed by Oakvale. They are subcontractors to Oakvale and came as a consequence of theselection of Oakvale.

Senator WEST—Who is Oakvale? Who are the principals?

Ms Bryant—Oakvale is a group of financial consultants who have extensive experience inthe development of major funds of this type. We can certainly give you a CV on them. Theyhave a background in development of Keystart and other housing loan type products for someof the state governments, some industry funds, et cetera. But we can actually give you a CVwhich will give you more detail.

Senator WEST—Not HomeFund, I hope.

Ms Bryant—No, not HomeFund.

Senator FORSHAW—When you say industry funds, do you mean industry superannuationfunds? Is that what you are talking about? You said they had experience in industry funds.My understanding of the term ‘industry fund’ is a superannuation fund, industry-based. I amconfused.

Ms Bryant—The details are eluding me at the moment but they have had some work withthe ferry industry and I think with the wheat industry and that sort of thing. We will get youthe details. They are individual industries.

Senator FORSHAW—But they are not superannuation funds, where the term ‘industryfund’ is commonly applied?

Ms Bryant—They certainly have done some work in those fields as well.

Senator FORSHAW—If you can get us that information, that would be good.

Senator WEST—In relation to whatever has been short-listed, what connections do theyhave to any of those on the team that initially started off the tender processing or the decisionsabout what directions to take?

Ms Bryant—I am sorry, Senator, I actually missed the beginning of your question.

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Senator WEST—Of the team that worked up the proposals and went and drafted theprudential stuff, are any of their companies or associates in the final short-list?

Ms Bryant—One of the reasons that we chose Oakvale originally was because, if I cancharacterise it, they are architects not builders so they were not likely to be a contender forthe subsequent running of the scheme. One of the three other members may be a tendereramong the 14 for the scheme manager position. We are not aware at this stage whether theywill respond to the tender. We are not aware whether they will be short-listed or whatever,but one of them is included in those who may tender for the scheme manager position.

Senator WEST—Does it have any connotations of conflict of interest or anything—it isnot insider trading but is it insider knowledge?

Ms Bryant—Because they were only involved in a very narrow aspect of the work, we didnot consider that they would have any overall advantage. All participants were given, as I said,the information and briefing session and an opportunity to seek more detail et cetera but, giventhe narrowness of their involvement we did not consider that that would be an issue.

Senator WEST—I guess we will have to wait and see.Senator FORSHAW—When were the prudential arrangements announced? Can you just

remind me?Ms Bryant—It was 5 or 6 August.Senator FORSHAW—Since then, which is about a week and a half ago, have any changes

been made, because I understand there have been some reactions and concerns expressed? Hasthe minister announced any further changes or decided on any changes?

Ms Bryant—Not to my knowledge. What has always been the case from the outset is thatthe legislation provides for the general scheme which the minister has announced. I am notaware of any changes in respect of that general scheme that she has announced. It has alwaysbeen a provision in the legislation that there could be specific alternate schemes.

The minister has indicated that, subject to them meeting the requirements to establish analternate scheme, she is open to considering proposals that may be brought to her. That maybe the area where you are thinking there has been some change, but that is a provision thathas been in the legislation from the outset.

Senator FORSHAW—I suppose we will just have to wait and see what ultimately comesout. With the money that is drawn down and the interest that is earned on the accommodationbonds, which you have now said will be paid monthly by instalments to their homes, theintention is that that be used for upgrading facilities, capital improvement et cetera. Tell meif I am wrong, but I would have thought that for some considerable period of time at leastit would not be possible for a nursing home to accumulate sufficient income to make anymajor upgrades or capital improvements, particularly if they are getting the money ininstalments.

It will build up, but it seems to me there is going to be a bit of a time lag before it actuallytranslates into upgrades and improvements. If we saying that the overall intention of thisscheme is to improve the stock of nursing home accommodation, aged care accommodation,then we are not talking about minor maintenance or putting on a coat of paint or something.We are looking at something which is a big ticket item and that requires time for planning,design work and all that.

What is the department’s estimate as to when you would start to see some real change inaccommodation? The money presumably comes out of the pool and accumulates in another

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fund that the nursing home would have to maintain—unless they are drawing off it for otheractivities.

Ms Bryant—I will make a couple of comments. First is the amount of work to be done byfacilities—the majority are obviously passing certification. Of those who have work toundertake, the extent of that work does vary quite a lot. There are some that have relativelyminor amounts that need to be expended to bring them up to the required standard.

The analogy I would use for people having the capacity to undertake work is that of youand I paying off a housing mortgage. You have an income stream and can borrow and servicethe debt on the basis of a new income stream that the industry has not previously had accessto. Using that income stream, we would anticipate that you would begin to see improvementsfrom the outset. The extent of them will obviously increase over time, but you will start tosee improvements from the beginning.

Senator FORSHAW—I remain to be convinced of that, to be frank. We will just have towait and see. It just seems to me that you are going to need to have quite a substantial amountof money invested in the pool from bonds to even begin to accumulate the sort of money thatmay be required for a capital upgrade on a facility. I appreciate that there might be little thingsthat need doing here and there, even medium size things, but I know from visiting nursinghomes in my own area—the sorts of money that they have looked for, made applications forin the past, and made representations to me and other people to put on their behalf—that weare not talking about a few hundred or a few thousand dollars; we are talking about a lot ofmoney.

Ms Bryant—We are talking of them using an income stream for commercial borrowingsand so on. That will mean that at a time when they have a sufficient income they willundertake those borrowings. Whilst there is some turnover of residents and that sort of thing,those changes will occur progressively and quite rapidly.

Senator FORSHAW—What proportion of the homes would you envisage doing that? Youare saying that the nursing home receives the bond, the bond is deposited in the central fundand the income and the draw down is paid by the central fund back to the nursing home ona monthly basis. That money is intended to be held on the basis of then developing a kitty,if I can use that word, or a bank, that then enables the nursing home to go to another lenderand borrow money on the basis of that income stream that they have from the residents. I amcorrect in that analysis? What proportion of nursing homes would you envisage being in thatposition?

Ms Bryant—Any nursing home that charges bonds will have an income stream from them.The extent of the income stream will depend on their particular charging practices, et cetera,but all who charge bonds will have an income stream which they can use to fund maintenanceand improvements to their facilities. The majority of the upgrading and improvement that takesplace in the industry already is funded through commercial borrowings, et cetera, on thecurrently available income streams, and there will be a new and additional one.

Senator FORSHAW—That is what I was going to lead to. That is correct. I would surmise,and I would be interested if you have any data on this, that in many of those cases the levelof the debt that they are servicing is substantial. I certainly know of some that are verysubstantial. I can think of a couple that I know, particularly in the centres run by religiousorganisations, where they are servicing a very large debt and I am sure that the last thing theywant on their plate is a further debt to service. Presumably they will use the funds to servicethe existing debt. They can do that, I take it?

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Ms Bryant—That is within the authorised purposes under the legislation, yes.

Senator FORSHAW—Thank you for that information. I think I know what your answerto this will be, but does the department accept the view of the ANHECA and the ACA andothers that the proposed prudential arrangements significantly undermine the efficacy of entrycontributions? I take it you do not.

Ms Bryant—The government had a commitment from the outset that residents’ moneys paidin the form of bonds would be completely protected, that residents would have that certainty,and I think that that is what it has sought to deliver.

Senator FORSHAW—I was going to ask what the government’s position was to counteractthe argument that the level of capital funding generated under these arrangements will begrossly inadequate to meet current and projected need, but we have already been down thattrack. That was a criticism made.

Ms Bryant—The government said in the last budget that it anticipated that accommodationbonds would produce around $130 million in income—by income I mean the draw down andinterest amounts earned from them—by around the fourth year, and that that would besufficient to meet the capital needs of the industry. Those projections that the governmentmade at the time of the last budget have not altered.

Senator FORSHAW—Has the department taken any steps to approve alternative prudentialarrangements for the major church groups?

Ms Bryant—The short answer is that the legislation provides for specific alternate schemes.

Senator FORSHAW—This is what you were referring to earlier. I understand that.

Ms Bryant—Yes. Draft criteria have been released for public comment in the user rightsprinciples which have been released as an exposure draft. We have had discussions withorganisations but have no applications and have taken no formal steps to approve any.

Senator FORSHAW—How do the draft ones compare to the requirements under the generalarrangements? Are they more or less onerous?

Ms Bryant—The requirement under the act itself is that any alternate scheme approved beas stringent as the general scheme. There have not been any schemes approved. We envisagethat alternative structures will be possible but the criteria for approving them will be that theydemonstrate an equal level of stringency.

Senator FORSHAW—I take it that the reasoning behind having alternative arrangementsis that, particularly the church groups, they have more of a systemic or organisational natureand run a number of homes rather unlike the individual nursing homes that may all beindividual companies. Is that the case?

Ms Bryant—The draft criteria certainly have size as a factor that may be taken into account.I think the draft currently provides that you have to have around 3,500 beds in total covered,so there is a size threshold. There are also requirements about the overall capacity of theorganisation—the asset backing, in a broader sense—which are intended to indicate their abilityto underwrite or provide a necessary level of certainty, on the basis of the broad organisationand not just the member individual facilities.

Senator FORSHAW—I have two quick questions to finish on this issue. Following on fromthe question I just asked, tell me if I am wrong but, for instance, with church-run nursinghomes—I do not know whether that is an appropriate way to describe them—you have asituation where they may have a number of establishments in a whole variety of places. I

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understand it is possible for the contributions go into a pool so that the organisation or churchgroup can utilise the money, in effect, in a cross-subsidisation way so that the funds generatedby the residents’ contribution in that home—which may be brand new and does not need anywork done on it—could nevertheless be used to improve the facilities in another location oreven ultimately to build another home or an extension. Am I right, or is the money lockedin to be spent within the home in which the resident is actually located?

Ms Bryant—Under the legislation, facilities are allowed to use the income from bonds forimprovements and maintenance, et cetera, for debt reduction, as we have already identified,and also, where no immediate building work, et cetera, is required, for the delivery of agedcare services. That last does allow them the capacity to cross-subsidise in that form.

Senator FORSHAW—I thought that was the case. I apologise if I have taken you overmatters that may have been dealt with earlier, but I just wanted to clarify it. When will thedetails be announced on these alternative and different arrangements? You have just said thatnothing has been signed off as yet, but it is only six weeks to 1 October.

Ms Bryant—As I say, we have released an exposure draft of the subordinate legislation withsome proposed criteria. In the light of consultation on those, I would expect us to issue revisedcriteria within the next two or three weeks that will contain further detail on the criteria thatmight apply.

Senator FORSHAW—So I can just finish my questions, Senator West has asked questionsin regard to classification, instrument training. I have some questions as well which I thinkI will put on notice rather than take you back over some previous ground.

CHAIR —Senator Gibbs, do you have any new questions?

Senator GIBBS—I would like to talk about the instrument training. How much was spenton this?

Ms Bryant—On the training for the single instrument?

Senator GIBBS—Yes, for the resident classification scale.

Ms Bryant—I understand it was contracted out to Australian Health Care Associates whothen subcontracted out to others.

Mr King —Overall, that whole contract is for just under $3 million. That involves trainingon the instrument on funding, and I understand it is an accreditation.

Senator GIBBS—How many people were actually trained?

Mr King —I cannot give the precise numbers at the moment. Roughly speaking, on theclassification instrument and the funding together, there were over 12,000 people trained.

Senator GIBBS—Is that all in the whole of Australia? Is it only 12,000 people?

Mr King —Yes, on those two. That represents a couple of people per facility. That isactually a massive training episode for this area. We expect to get another 6,000 or 7,000 togo through the third module over coming weeks on the classification.

Senator GIBBS—Three million dollars spent on 12,000 people to be trained. That is a bitexorbitant, isn’t it?

Mr King —It equals around about $150 a day per person.

Senator GIBBS—A hundred and fifty dollars a person?

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Mr King —Yes, for all the things that are involved in that. If you compare that with thecosts of training sessions for individuals which are advertised, they can often cost a lot morethan that for single days, so I think it was quite cost effective.

Senator GIBBS—So it is one day’s training—is that what you are saying?Mr King —Yes.Senator GIBBS—And two people per accommodation place and they are supposed to go

back and train the others?Mr King —It is providing the basic information for that facility.Senator GIBBS—Are these registered nurses who are being trained or are these the people

that we are taking off the street to work in these places?Mr King —No, it is for the people that the services nominate—that is, their existing staff—

which will include their nurses and their management staff, depending on the actual coursethat is involved. Some of the bigger groups will send their trainers along who will go backand train other people.

Senator GIBBS—How many properly qualified registered nurses, who actually know whatthey do when they give you an enema or stick a needle in your arm or a tube up your nose,are going to have to be in these nursing homes per patient?

Mr King —That is a different issue. There are a range of provisions in the act relating tothe staffing requirements for services. There is a basic requirement to have an appropriatenumber of adequately trained staff and that covers hostels and nursing homes. The focus isupon what specific residents you have, what needs they have and whether you have the stafffor that. In particular, there are some minimum requirements, the final wording of which isjust being settled now in the prescribed services which relate to how many staff of a certainnature you must have as your resident mix gets more dependent.

That is still being settled, but broadly speaking it requires access to qualified staffing orsupervisory qualified people once you start getting high-care residents—roughly speaking,those in nursing homes. Once you get to four of those people, you need to have someone thereon site the whole time, and once you get into eight or more then you will get to have someone,a qualified nurse, there the whole time. That is a minimum, and in many places you requiremore than that. That is putting in a baseline.

We continue to monitor standards and there is an expectation there of the level of care thatis being provided. The accreditation process will go ahead. We will go into that in more depthrather than just looking at the number of people you have. We will then be looking at whatthe base skills are that they have, how well they are updating them, whether they are trainingpeople and looking ahead—again, more than just a single number, an input, taking it back tothe needs of the people they have in the facility and the way in which they have a staffingprofile and a skill mix and are updating the skills of those staff.

So there are a whole range of things which are in place to make sure that the skilled staffare there where needed. I need also to point out that people other than nurses can do a rangeof things and can be trained to do them and can do them properly. There are other areas whereyou do need nurses as well, and it is getting that mix right for each facility which is the issue.

Senator GIBBS—So when you talk about adequately trained and qualified staff, are we onthe same wavelength here? If you go into a nursing home, you go in to die, basically, do younot? About 80 per cent of patients when they go into a nursing home die in the first sixmonths. You do not go into one of these places for the fun of it, you go in because you are

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incapacitated, you are gaga, you cannot do anything, you cannot look after yourself and mostof them do not even know they have got dementia.

I would imagine that if I was in that sort of position—which I will not be because my familyare under certain instructions that they will not let me get that far—I would want a registerednurse actually looking after me, not somebody who was ‘adequately trained’. I know of a casewhere someone who was ‘adequately trained’—he was not a registered nurse—gave a patienttwo enemas. An enema is not just something that makes you go to the toilet, it is a drug, andthis patient died because the person giving the enema was not a registered nurse.

So are we on the same wavelength? Are these staff going to have to be registered nursesor enrolled nurses under the supervision of registered nurses, or are they just going to bepeople that we pick up and train? This is very important.

Mr King —The basic answer is that a nursing home looking after high care residents willindeed have registered nurse staff and enrolled nurse staff there. When I say ‘the appropriaterange’, it depends upon the mixture of residents in that facility. The legislation covers hostelsas well as nursing homes, and we will be looking at that mix of residents. If they have a lotof high care residents then we would expect them to have registered nurses there. There area range of things which only a registered nurse is capable of providing. Where it requires aregistered nurse to deliver them, you need a registered nurse there to deliver them, and wewould be looking to make sure that those services are provided.

Those are the sorts of things that we picked up and worked through. Both the standardassessments which will continue from now on and the accreditation process will go into thatin more depth—how you have chosen to structure your staffing, including registered nurseand enrolled nurse staff.

At the other end you will have hostels, some which may not need to have any qualifiednursing staff. You will have a range of other facilities which will have a mixture of staffing.That is no different from now, in one sense.

Senator GIBBS—I would say that at the moment, nursing homes would have nursing staff.If that is the case, then how would you account for the situation in one nursing home that Iknow of, Eventide in Brisbane? As of 1 October, Eventide is making 40 of their nursesredundant, to replace them with qualified staff who are not nurses. This is going to happeneverywhere; so really you are putting our aged people—and we are going to be there one day,too—at extreme risk.

Ms Bryant—Senator, Eventide is a state government nursing home.Senator GIBBS—I know, and 40 nurses are being made redundant. Did you know that,

Minister?Senator Herron—No, I did not, Senator Gibbs.Senator GIBBS—Forty is a lot from Eventide.Ms Murnane—We would have to look at the total context of that. But I would make the

point—and I think this is a very relevant point—that the requirements that Mr King pointedout before in relation to having qualified nurses on site to meet certain resident needs are, infact, a milestone. Those requirements were not there in the previous Commonwealth act; soyou could say that as a result of the new legislation the situation is made tighter in terms ofqualifications of staff, particularly requirements for qualified nurses.

Senator GIBBS—Last week I had a meeting with a number of qualified nurses and theirunion. They were from nursing homes, and they are all frightened of losing their jobs. Eventide

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is shedding 40 nurses. That is quite a number of nurses from one establishment. The wholecurrent throughout these areas is of qualified nurses who are going to be made redundant.

Ms Murnane—We will talk to the Queensland health department about the Eventidesituation; but that is, as you know, a very large facility. We would need to look at that in thetotal context of the plans for that facility and for that part of Queensland.

Senator GIBBS—But there were nurses there also from private nursing homes, and theywere frightened for their jobs. They had no guarantee that after 1 October they were not goingto be culled.

Ms Murnane—Of course, people can be frightened for their jobs, and any sort of changebrings a certain amount of fear in its wake. But what Mr King has been saying, and what Iam saying now, is that there is nothing within the new legislation, nothing within the newpolicy regime, that gives cause for the quantity or quality of staff to be reduced.

Senator GIBBS—But the legislation does not mention the word ‘nurse’; that is the problem.It is ‘qualified people’. What are ‘qualified people’ supposed to be? You can take a typist andput her through some course and say, ‘Go and look after this sick person;’ but if it was me,I would say ‘No, thank you very much.’

Mr King —What I was referring to actually says ‘qualified nursing staff’. I think one of thethings that will be covered in the training around the accreditation and standards will be thestaffing requirements, simply so people are aware of them. To the extent to which anyone hasthe misapprehension that they can get away without having appropriate staff there, they willbe made aware that they will not be able to do that, and that there are expectations.

I also think, broadly speaking, that if you hear allegations of large numbers of staffreductions of the registered nurse nature, the department is quite happy to look into them tomake sure the standards in those facilities are being maintained, that they do have the rightstaff there and that they are providing the care. They are the sorts of indicators and storiesthat, if we hear them, we will investigate to make sure there is no truth to them. We willinvestigate the extent to which the care is not being provided.

We follow up on those to see what is happening in those facilities. If we find them and catchout people whose standards have dropped a lot because of that, then they have limited excuseand we will make use of the powers we have under the new act and force those places eitherto improve the care by getting proper staff or to face the regulatory action which we can take.[9.56 p.m.]

Program 6—Disability ProgramsSubprogram 6.1—Employment Assistance

Senator GIBBS—In the June estimates, my question No. 107 related to the employmentassistance program, and the answer was that there would be no decrease in the servicesprovided. That is with the cut. What I would like to know is: if there is to be no decrease inthe services provided in the employment assistance program, considering that 15 staff havebeen cut, how can this be achieved? This is basically a 10 per cent decrease in staff. How canyou cut 10 per cent of your staff, which is 15, and not have it jeopardise the program?

Mr Cochrane—In that previous questioning during the Senate estimates, we explained themovement in those staff numbers. Certainly, the staff movement represents no threat to thelevel of services that are being provided.

Senator GIBBS—Sorry, could you repeat that?

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Mr Cochrane—We explained in the last Senate estimates that the movement in staff doesnot represent any decrease in the amount of service that is being provided in the program.

Senator GIBBS—You have just moved them somewhere else, have you?

Mr Cochrane—Can I have a moment to find the answer that we gave you? Basically, weanswered that the staff figures in the budget statement are incorrect and the figure should read163.7 staff rather than 138.6.

Senator GIBBS—You had here, ‘See question No. 117’, but I do not have No. 117 here.Thanks very much. My question No. 109 was: each year approximately 1,500 students withdisabilities leave school. In this year’s budget, there were no employment places announced.Does this mean that the students will have to remain dependent on their families? The answerwas that funding available under the disability employment assistance program includes a twoper cent growth factor. It goes on to talk about school leavers. The follow-up question to thatis: I was told that 640 people moved into open employment in 1996. How many of the 1,500students with disabilities leaving school this year will be assisted in finding employment?

Mr Barson—I can assist with a further answer to the question that was asked before. Atthat stage the government had not announced any additional employment places for that year,so the answer was correct at the time. Soon after the Senate estimates met and that questionwas dealt with, the minister approved funding for an additional 1,000 people to be assistedin employment during the year. So the answer at the time related to the conditions at the time.Following that, an additional 1,000 people are going to be supported in employment. That isin addition to the number of support services that become available as people move fromsupported employment into other forms of employment.

Senator GIBBS—Thank you very much.

Mr Barson—I should add that school leavers are a significant priority group within that.

Senator DENMAN—Why is the Commonwealth developing a new funding formula if itslong-term intention is to devolve employment services to the states?

Mr Cochrane—There is no long-term policy agenda to devolve employment services tothe states. It is an issue that has been discussed from time to time and we have done somework with state governments in looking at what the policy opportunities might be. But at themoment there is no ongoing discussion aimed at devolving employment services to the stategovernments.

Senator DENMAN—Is the minister in a position to judge those options that provide betteroutcomes for consumers and, if so, could the minister advise what the options are that are nowbeing seriously looked at?

Mr Cochrane—Options for better outcomes—in what context?

Senator DENMAN—I imagine that it has to do with the formula for employment.

Mr Cochrane—Certainly, the core objectives in looking at the question of employmentfunding reform are to offer consumers better choice, to encourage providers to be focused onachieving outcomes for consumers, to make sure that there is equity of funding in theemployment area and that the access is there to accompany that equity.

Senator DENMAN—In answer to a question that I placed on notice previously, questionNo. 166, I was advised that the Commonwealth was in the process of conducting a reviewof employment services in Western Australia to ascertain whether an improvement could bemade in the coordination of services between Commonwealth, state and territory governments

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for the benefit of consumers. Has that review been concluded and, if so, could I have a copyof the results?

Mr Cochrane—The review has not been concluded. Work is still being done in cooperationwith the state government in reviewing the service providers in Western Australia and localissues surrounding employment opportunities in that state.

Senator DENMAN—Have you any idea when it will be concluded?

Mr Cochrane—I think we would be aiming to get a result from that review probably withinthe next three to four months, but it is obviously dependent on the cooperation of the stategovernment.

Senator DENMAN—Could I be provided with some detail as to how the department andDEETYA, in their high level discussions, are going about ensuring that people with a disabilityhave access to the service that best meets their employment needs?

Mr Cochrane—Discussions between us and DEETYA are occurring on a number of plains.One is centred on the employment reforms that are going on in DEETYA and the proposalsin DHFS. That discussion includes areas that cover revised assessment procedures andrationalising the client groups between DEETYA and ourselves. I think the real question youare getting to there relates to the cashing out of some DEETYA programs that were previouslyavailable to some of our client group, that is, in the context of employer incentives. Thosediscussions are still continuing.

Subprogram 6.2—Commonwealth Rehabilitation Service

Senator GIBBS—I wish to follow on from questions asked in June—question Nos 120 to122—with regard to cuts to the Commonwealth Rehabilitation Service. Apparently, the answersrefer to commercialising CRS and more traditional areas to be opened up to other privateproviders. Will the clients of the government pay for these services, considering that we areopening up to private enterprise?

Ms Murnane—You are asking: will clients who are currently in receipt of the disabilitysupport pension or some other income security—

Senator GIBBS—Yes, those who receive the pension.

Ms Murnane—be asked to pay for this service; the answer is no.

Senator GIBBS—They will not?

Ms Murnane—No.

Senator GIBBS—It is going to be commercialised and apparently revenue is expected toincrease by 10 per cent. How are you going to increase revenue by 10 per cent if they haveto compete with private enterprise?

Mr Law —The specific question you refer to is in question 121 that was asked on noticeat the previous estimates committee. That 10 per cent relates to the other business of CRS,which is a provider of Commonwealth funded rehabilitation programs. As well, it does operatein a broader market for other commercial activities. That 10 per cent refers to growing thatother commercial business where we compete with private providers. It does not refer to theCommonwealth funded component.

Senator GIBBS—Thank you. That is basically all I have on that one.

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Subprogram 6.3—Commonwealth/State disability agreement

Senator DENMAN—I understand that an extra $25 million was allocated for the CSDAat a meeting on 30 June. Is that correct?

Mr Cochrane—An extra $25 million was offered to the states for a long-term CSDA.Senator DENMAN—I had information from an observer that the Commonwealth went into

the 30 May discussion with more than $25 million and that the additional funds, over andabove the $25 million, would have been forthcoming if the state ministers had lobbied harder.Is that accurate information?

Mr Cochrane—We went into that meeting with two sums of money—the $54 million thatwas allocated in the last budget and the offer of $25 million. They were the only two amountsof additional money that were put on the table.

Senator DENMAN—Is the Commonwealth contemplating developing core fundingagreements?

Mr Cochrane—The proposal under the CSDA framework that we are looking at is to havean agreement that has a multilateral core that covers things like accountability and the broadfunding arrangements. It also provides for a bilateral framework that can be pursued to lookat various issues that are pertinent to individual states.

Senator WEST—What is the current funding situation on that CSDA? Is it on a month-to-month basis?

Mr Cochrane—Yes.Senator WEST—How long is it expected that that will last?Mr Cochrane—When ministers met in Cairns a few weeks back they agreed to extend the

current agreement on a month-by-month basis until February 1998.Senator WEST—Disability Newswent out to everybody and the July edition was a big flash

edition. It talks about the ministers wanting longer term agreement. We see within weeks ofthat hitting the news stands that we are down to monthly agreements. How does that comeabout?

Mr Cochrane—We are still in the process of trying to negotiate a longer term agreement.In the interim, so that people with disabilities were not put in a position where they weresuffering because of a lack of Commonwealth funding, we have agreed with the states’proposal to extend it on a month-by-month basis so the Commonwealth money still flows. Theend objective is to provide people with some certainty and continuity of service and that iswhy the Commonwealth is so keen to have a longer term agreement.

Senator WEST—Do any of the states agree with what you are proposing?Mr Cochrane—If we were in agreement we would have the agreement settled. Obviously

there is still a dispute between the Commonwealth and the states on funding arrangements.Ms Murnane—The fact that we are renewing the current agreement until February with

a view to negotiating with the states for a longer term agreement means that there is a desireon the part of the states as well as the Commonwealth to reach a situation where, at the endof this year or early next year, we can all sign up to a longer term agreement.

Senator GIBBS—It is my understanding, though—and correct me if I am wrong—that on30 July the Minister for Health and Family Services simply informed the state and territoryministers that the Commonwealth had decided that morning not to sign the interim one-yearagreement, and they were stunned.

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Ms Murnane—Senator, that is partly true. The minister did tell the state ministers that thegovernment had decided that it was still looking for a longer term agreement and did notregard a one-year interim agreement as a realistic step towards that. But the government alsodecided—and the minister conveyed this—that it did not want services to be in any doubtabout the flow of Commonwealth funds and so the existing agreement would be renewed ona monthly basis in the hope that we would soon reach agreement with the states for somethingthat was longer term and would give continuity and security to people with disability and theirfamilies.

Senator GIBBS—How much longer is the minister looking for?Ms Murnane—We are in the process of negotiating with the states. The deadline that the

states and the Commonwealth have set themselves in this now is February. By February, wedefinitely want to have a longer term agreement. We are hoping it will be before that.Ministers agreed that they would meet again in November.

Senator GIBBS—But does the minister want a five-year term or—Ms Murnane—The minister has been on the record as saying that a five-year agreement

is the length of agreement that she considers most desirable for giving a band of time that cangive continuity to people with disabilities and their families, and also provide a sufficientlength of time for the Commonwealth and the states to work together to improve the servicesprovided under the program.

Senator GIBBS—Thank you.CHAIR —Any further questions on 6.3? If not, we will move on to 6.4.

Subprogram 6.4—Access and participation

Senator GIBBS—I have one question. This is in regard to answers to questions that I askedin June on the national disability advocacy review. Apparently, at the time, they had notcompleted the work. Has the work now been completed and, if so, what were its recommenda-tions in relation to the future of individual advocacy groups?

Mr Cochrane—Since we were last here, the work has been continuing, including a ratherlarge national consultation. The consultation included an offer to the community to make inputinto the review. The cut-off for input was only the 18th, which I think was yesterday, so weare still going through the process over the next few weeks of being able to analyse the resultsof the community consultation and prepare a final report for the minister.

Senator GIBBS—When that report is handed down, will that be made public? Will we geta copy of it?

Mr Cochrane—It is a question for the minister, but we will certainly be making ourrecommendations to the minister and I would assume that there would be a public result.

Senator GIBBS—Thank you very much. Apparently the advocacy organisations have beenoffered contracts for 1997-98, pending the review. Does this mean that these contracts can nowbe cancelled at short notice or at any time during this financial year?

Mr Cochrane—No, the contracts are for the duration of the financial year.Senator GIBBS—So they cannot simply be terminated?Mr Cochrane—No, we cannot just terminate them.Senator GIBBS—Thank you. That is all I have.CHAIR —Any further questions on 6.4? If not, we will move to program 7.

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[10.19 p.m.]

Program 7—Corporate leadership and managementCHAIR —I believe Senator Neal has put some questions on notice on program 7. Any

further questions on program 7?Senator WEST—I want to ask about computers. I am not sure whether that is 7.2 or 7.3.Senator FORSHAW—I just have a couple of questions. I do not think they are going to

take very long.CHAIR —Go right ahead.

Subprogram 7.2—Corporate services

Senator FORSHAW—This is a written question that was asked on notice on 4 Juneregarding ministerial office equipment: ‘Can the department provide a complete list ofequipment provided to the minister’s offices, both in Canberra and Melbourne, including butnot limited to, computers, laptops, mobile phones, video records, televisions?’ The answer was:To obtain the information sought would involve considerable research and the minister has not authorisedthe time and resources entailed in collecting this information.

Could I have an explanation as to why this would involve considerable research and,presumably, time and resources?

Ms Murnane—I am just studying the question, Senator.Senator Herron—I will let you know mine, if you like.Senator FORSHAW—I was thinking of asking you, Minister.Senator Herron—You can ask me, I will walk you around it. I have seven staff, five

computers and probably five mobile phones.Senator FORSHAW—Keep going.Senator Herron—That is about it, I think.Senator FORSHAW—It is interesting that you can tell me yours but the minister for health

apparently cannot tell us his.Senator Herron—He has a bigger department than I have.Senator FORSHAW—We are talking about equipment in his offices, not the entire

department.Ms Murnane—I am just re-repeating the answer: it would have involved considerable time

and research and the minister was not willing to authorise that. We could go back to him andtalk about it again.

Senator FORSHAW—I would like you to do that.Ms Murnane—We will do that.Senator FORSHAW—I have to say, with no disrespect to you, Ms Murnane, that I find

this answer grossly insulting. Really, to suggest that an inventory or list of what is in his officecannot be provided defies one’s imagination. There must be a list kept somewhere. They knoweverything that is in my office. About once a year they come around and check that it is stillthere.

Ms Murnane—The point is that the question was asked at the wrong time of the cycle, andwould have involved some special work. We have caught up in the cycle of stocktaking sowe will take it back to the minister and get his view.

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Senator FORSHAW—I would appreciate that. Even if the information that could have beenprovided at the time was the previous list and an indication that a further list was beingupdated. I assume he does not have televisions coming in and out of his office every day.

Ms Murnane—No, not at all.Senator FORSHAW—But then again, I do not know.Senator WEST—If there was a ministerial change tomorrow, presumably the department

would know what equipment it had to get back. It would be able to find that out very quickly.It would have a record somewhere of what equipment was in the ministers’ offices. Havingworked in ministers’ offices, I have always found that to be the case.

Senator Herron—I suspect that it is less than the previous minister’s.Senator WEST—That is okay, that is not a problem, Minister.CHAIR —Ms Murnane has given an undertaking to take it back to the minister, and she has

given an answer as fully as she can. Any other questions?Senator Herron—We will find out for you.Senator FORSHAW—This question was also asked: ‘Has the department engaged any new

consultants since the last date it provided to the committee?’ This is question No. 293. ‘If so,will you provide the same information for these new consultancies?’ The answer was:Information about consultancies is currently being collected in preparation for input into the department’sannual report and can be made available to the committee once it has been finalised for the annual report.

When is it likely to be available?Mr Tomkins —We expect to have that information available at the end of October.Senator FORSHAW—Thank you very much. I might just make one other comment in

regard to the question about ministerial office equipment. I could be wrong, but myrecollection is that that question was asked across all of the departments, of all ministers inestimates.

Subprogram 7.3—Information Services

Senator WEST—I want to know what is going to happen to the Department of Health andFamily Services computers and their programs when the clock rolls around from 31.12.99 to01.01.00, and how much it is costing. It might be a joke to some, Minister, but it is not toothers.

Senator Herron—No, I have seen today’s papers. The estimate is $100 million for thecommercial banks, and I would have thought that our computers—

Senator WEST—For DSS it is $10 million.Senator FORSHAW—I saw estimates that this was going to cost hundreds of billions of

dollars world-wide—a phenomenal cost.Senator Herron—That was in today’s paper. It is a good question, that is why I was smiling

when you asked it: it is a pretty valid question, and I will be interested to hear the answermyself.

Dr Heath—Like all parts of government, we have a year 2000 issue which we are dealingwith. We have done a complete review of all of our equipment and all of our applications,and we believe we have identified what needs to be done to make the whole of our computingsystems year 2000 compliant. We are in the fortunate position that a significant proportionof our applications have been redeveloped in the last couple of years, and we have had year

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2000 compliance rules in place since 1990. There are only a couple of applications which wehave identified on which there is still work to be done.

We have been reviewing all of our equipment, and at this stage we do not believe we haveany significant issues on the equipment side, except possibly for some desktop PCs. We havenot yet been able to get satisfactory answers from the manufacturers as to whether in fact thoseare year 2000 compliant.

You asked a question about our estimated costs. At this stage we are estimating that it isonly going to cost us $750,000 in total expenditure to change the applications that need tobe changed and to test that we are in fact year 2000 compliant.

Senator WEST—Have you any idea what it has cost to date?

Dr Heath—That is the total estimate. We started work on the year 2000 compliance planin the middle of last year, and that is an estimate of the cost since that time, so the changesto the applications that occurred prior to that date are not included in that figure.

Senator WEST—Right. I was thinking that if you have been doing it since 1990 then theremust be other costs.

Dr Heath—That is right.

Senator WEST—Is that just for the Department of Health and Family Services, or doesthat include agencies?

Dr Heath—It is just for the department of health.

Senator WEST—So it does not include the HIC?

Dr Heath—It does not include the HIC.

Senator WEST—Can we put that question on notice to them, then, please? I know it is abit late, but it just struck me that they are one of the ones that actually do interface with othercomputers. What other agencies have you got that would be interfacing with other computers?Can I leave that one with you? I cannot think of anything off the top of my head, apart fromHIC, but perhaps I can leave that as a general question to you. Some of the things like theNHMRC and PBAC might interface with other agencies and departments. How are they going,and what is the costing for them going to be?

Senator Herron—Could I ask a supplementary question?

CHAIR —Feel free, Minister!

Senator Herron—It is in the interest of all our knowledge. Was the guidance that wasfollowed by the department in this regard similar to that in other departments, or did you makeyour own decision in this regard?

Dr Heath—It is long before my time, Senator, but my understanding is that generally inapplication redevelopment work in the 1990s people have been very conscious of the year2000 problem, and redevelopments of applications have usually been year 2000 compliant.

Senator Herron—Is that right across all government departments?

Senator WEST—If you could find out for us that would be helpful.

Dr Heath—You talked about the HIC, which I cannot speak for, but I know that their majorapplications have not been completely redeveloped since the middle of the 1980s so therewould be a different set of issues.

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Senator WEST—They are going to have to interface with a lot of other people—they havetheir own network but they also have some interface with doctors and pharmacists and thatsort of thing.

Dr Heath—Most of that network is of recent origin.Senator WEST—So it is probably okay. I am just interested and I suspect that the year

2000 policy that was developed in 1990 might have been a government one—I cannotremember. I think Social Security said they had started a policy in about the year 1990 too,so it is an interesting question, Minister. It is a serious issue and I have had other departmentsjust dismiss me as though I am mad, but I am glad that Social Security and Health arerecognising it as a serious issue, so thank you.

CHAIR —Are there any further questions on program 7?Senator FORSHAW—I think that completes all the questions from us. On our behalf, I

thank the officers, the minister and the Hansard staff.CHAIR —Thank you, Minister and Ms Murnane. I wish Mr Podger a speedy recovery and

yourself, Ms Murnane, and I thank all the officers. Thank you very much to Hansard and thesecretariat. Various questions have been placed on notice from Senator Harradine on programs1,2 and 6; from Senator Faulkner across programs and on program 2; from Senator Forshawon programs 1.4, 2.1 and 5; from Senator Neal on 1.2, 4.1 and 7; from Senator Mackay onprogram 6; from Senator Denman on programs 5 and 6; and from me on program 7. Thankyou very much.

Committee adjourned at 10.32 p.m.

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