North Coast NSW Medicare Local’s Vahid Saberi and Dr Dan Ewald presenting to the Senate Select Committee on Health in Lismore.

Robin Osborne reports on the Lismore hearing of the high-level Senate Select Committee on Health.

Given the balance in Australia’s new Upper House, the once powerful Labor-Greens forces rarely get a chance to dominate Senate related activities.

However, a whiff of past power was in the air at the Lismore Workers Club on 15 September when the Senate Select Committee on Health held a one-day inquiry into local views about health care planning and service delivery.

The Committee’s terms of reference are detailed on the inquiry’s home page

The criteria include a focus on Indigenous and rural health, the better integration of Medicare related services such as access to GPs and other care providers, and the implications of “reduced Commonwealth funding.”

On paper, the Committee has a good political balance – unless the PUP party is seen as being just as essential to fairness as it is to the passing of legislation.

The Coalition members are Senators Sean Edwards, Lib SA, Zed Seselja Lib ACT, and John Williams, Nats NSW, while Labor has NSW Senators Deborah O’Neill, the Chair, and Doug Cameron, and the Hon Jan McLucas, Vic.

There is also Greens Senator Richard Di Natale, an experienced GP.

However, the roadshow that came to Lismore, like Townsville before it, the only other Committee hearing yet held in a regional setting, included none of the Coalition members.

The resulting imbalance gave the attending senators - NSW Greens Senator Lee Rhiannon stood in for Dr Di Natale - ample opportunity to welcome comment on what they clearly see as key shortcomings in the Abbott government’s May Budget.

Uppermost on their hit list was the proposed $7.00 GP co-payment, dubbed a ‘GP tax’ whenever suitable opportunity arose. Implicit criticism was also directed at the government’s planned abolition of Health Workforce Australia, and lack of enthusiasm for preventative health, an example being the imminent scrapping of the Australian National Preventive Health Agency.

Anyone attending the Townsville hearing, or perusing the Hansard transcript on the Committee’s website, would hardly have been surprised at the partisan tone of the proceedings.

Kicking off that hearing, Sen O’Neill, said, “In the community more broadly, we are very aware of people's ire at the prospect of Medicare co-payments and of the importance of the sustainable health care provided by access to Medicare… “We know the impact of powerful health promotion, prevention and early intervention will make a difference in the lives of Australians.

“We have had great success in extending life expectancy, in reducing the rates of smoking and in many chronic issues of health concern. So with cuts to health promotion, prevention and early intervention, we want to understand what is happening in local communities with regard to that.”

In Lismore, there was no shortage of well-informed locals to satisfy their needs.

Axe the ‘tax’, foster good health

Speakers included Sandra Handley from Northern Rivers Women and Children’s services Inc, who spoke of a range of under-funded service gaps, from pregnancy terminations to eating disorders.

When Sen McLucas asked about the likely impact of a $7.00 GP co-payment, Ms Handley replied, “It would limit access, mostly for vulnerable women… I think it will significantly reduce affordability.”

In a question that would be directed to each speaker giving what the Committee termed ‘evidence’, Sen McLucas asked whether she had raised her concerns with the new federal Member for the seat of Page, the Nationals’ Kevin Hogan. Ms Handley said she had not.

It was a good political touch. Seated in the garishly carpeted room was the former Page MP, Labor’s Janelle Saffin, waiting to give ‘evidence’ about such matters as… the $7.00 co-payment, the importance of a preventive health focus (“It would be criminal if that goes”), and so on.

As one speaker told the Committee, Page is number 11 on the nation’s ‘top 12’ list of unhealthy electorates.

Over the next few hours the Committee heard from GP Jane Barker and RN Elizabeth Dolan, a MND carer, an exercise physiologist, a physiotherapist, Northern Rivers Social Development Council CEO Tony Davies, LBH nurse and union rep Gil Wilson, UCRH Director Prof Lesley Barclay and Education Director, Dr Michael Douglas, North Coast NSW Medicare Local CEO Vahid Saberi and Clinical Adviser Dr Dan Ewald, and family relationship centre, Interrelate Lismore.

Each had specific issues to raise, including the risk of greater ED pressures if the $7.00 ‘tax’ were introduced; NSW-Qld cross border arrangements; the benefits of Multi-Purpose Services; and the area’s new palliative care model. Clearly, the senators were impressed.

Key views held in common included the challenges of providing high quality, accessible health services in a region of socio-economic disadvantage, and the need to keep people out of hospital whenever possible.

Caring for one’s own health - keeping ‘fit and well’, as one witness put it – gained traction, and it might be suggested that the region’s residents are fairly successful in doing so: as NCML’s Vahid Saberi said, just 8,000 people in the Medicare Local’s footprint (of around half-a–million) use 80 per cent of the hospital bed stock.

However, the high burden of chronic disease, especially problematical in the Indigenous population, dispels optimism. Doubtless, there is a need to follow heathier lifestyles, and, judging from much of the ‘evidence’, a need for governments to encourage and assist us to do so.

Of course this is old news, and underpins the reasoning for the health reform agenda undertaken by previous Labor governments, however clumsily implemented at times.

Whither, Medicare Locals?

With the nation’s Medicare Locals currently in limbo-land, pending a reduction in their number and a forthcoming tender process, the Opposition senators seemed as keen as anyone to inquire about the program’s future.

“Are there risks to the community if the program collapses?”, Sen O’Neill asked Mr Saberi, adding, “Not everyone is happy to talk to us on the record.”

She thought that the 61 Medicare Locals might be reduced in number to 25.

“I’ve heard 30 or 32,” Mr Saberi said, adding that he didn’t oppose a name change, and explaining the steps between now and mid-2015 when the new program should be in place.

He advocated an EOI call as the first step in the tender process, with approval to manage the future primary care network being given to Medicare Locals which were the only interested bidder.

As he said, this would save considerable time and money. It remains to be seen if logic in health care planning will be any greater under the Coalition than under Labor.

Mr Saberi was also asked whether regional health concerns had been raised with Page MP Kevin Hogan – although he is only one of the federal Members within its footprint. He said this had not occurred “directly, as such”, but the MP was involved with the regional health leadership group involving the NNSW LHD, NCML, NRGPN, UCRH and others.

In the Townsville session Sen O’Neill had left no doubt about where she stood on Medicare Locals, the lynchpin of the former government’s primary health care agenda: “We understand very much that in recent years, with the development of Medicare Locals, many of the gaps that existed between these critical services were bridged. Efficiencies were gained and in addition to that people's health outcomes were improved.”

The Senate Select Committee on Health was formed on 25 June 2014, and is scheduled to provide a final report to the Senate on 20 June 2016 – a month after the Budget that will precede the next federal election.

Many more hearings will take place between now and then, but unless the wind changes dramatically, the report is unlikely to bring cheer to the government benches – especially if the Committee’s Coalition members fail to attend hearings.