National Health Amendment Bill

13 September 2017

House of Representatives

Monday 20 March 2017

I have been a registered pharmacist for 20 years. I have worked in both community and hospital pharmacy in Australia and overseas. My goal, in this place, is to work towards the better health of my community. The people of the Central Coast deserve accessible and affordable healthcare. They deserve to be able to see a doctor, when they need one. They deserve access to medicines, when they need them. This is only possible through support for Medicare and the Pharmaceutical Benefits Scheme.

Labor supports the National Health Amendment (Pharmaceutical Benefits) Bill, and I am pleased to support the bill, because we recognise that even modest changes can have a positive impact on the administration of the PBS. However, having grown up on the Central Coast and worked at Wyong Hospital for the last 10 years, I cannot stand by while this government undermines Medicare and the PBS and while the New South Wales Liberal government is in the process of selling off Wyong hospital. I cannot ignore their failings when it comes to the delivery of important IT reforms. And I cannot excuse their ideologically driven agenda that is hurting my community.

This bill makes three technical, but nonetheless important, changes to the administration of the PBS. It will allow online services to process PBS claims and prescription authorities, improve location rules for pharmacies affected by disasters and ensure concessional patients are covered until the last day of life. The changes to the supply of pharmaceuticals after a disaster or in exceptional circumstances will mean pharmacists whose premises have been affected by natural disaster or emergency, such as fire or flood, can supply PBS medicines from a nearby location for up to six months. Under the current location rules, pharmacies are restricted on how often and how far they are able to move from their PBS approved site. This amendment will see the relocated pharmacy receive the full PBS subsidy, not the current 90 per cent, without the need for separate PBS approval at the new site for up to six months, or in some cases longer, depending on the circumstances.

The Ourimbah Pharmacy, in my electorate of Dobell, on the New South Wales Central Coast, was the victim of arson attack in May 2015. The pharmacy owner, Anna-Lee, tells me it was an extremely stressful time for her and the patients she cares for. Because of the nature of their stock, pharmacies need stringent security measuresand in fact the arsonists that destroyed Anna-Lee's pharmacy gained entry by unscrewing roof panels. Anna-Lee says the administrative burden of applying for approval to trade at a temporary location, in addition to the refurbishments needed to any commercial space to make it secure and fit for purpose, made the task an enormous one. Patients rely on their pharmacists, particularly those using Webster-paks. On the day after her pharmacy was destroyed by fire, Anna-Lee set up outside the gutted chemist shop to see patients who rely on her. The rebuild took 4 months to complete, but Anna-Lee tells me it was more than 12 months till she felt the pharmacy was back to its original capacity. With this amendment, pharmacy owners like Anna-Lee will be better supported to continue serving patients after a disaster, a fire or a flood, which would have made a big difference for Anna-Lee and the patients she cares for.

The bill also clarifies that PBS benefits can be provided to concessional beneficiaries and their dependants on the day of their death. This replaces an anomaly in the current law where, in line with social security benefits, concessional entitlements cease on the day prior to death. According to the government, of the 146 million PBS prescriptions that were filled for concessional beneficiaries last year, less than a thousand were supplied to people on the date of death. This is a positive change, particularly for those pharmacies servicing the aged-care sector, and for those already out of pocket the backdating of the measure to 1 April 2015 will be welcome. I acknowledge the Pharmacy Guild of Australia for putting these two important issues on the government's agenda and thank them for representing the interests of their members and our community.

This bill also refers to the streamlined processing of PBS claims using online services, and online processing of approval requests for doctors to write certain prescriptions. The government says this bill 'will enable the claims computer system to match payment assessments against a pharmacy's certification of supply and take the administrative actions that would otherwise be taken by the Chief Executive Medicare'. Of course, pharmacists lodge prescription claims online as medicine is dispensed, and have done so for over a decade. According to the Department of Human Services annual report, 99.9 per cent of approved suppliers used online claiming last year.

A lot of things have changed since my graduate training year in 1996. Like a lot of new pharmacists I was tasked with processing the claim. At the time, this manual process required sorting prescriptions into categoriesgeneral, concessional, repatriationcollating them in numerical order and bundling them up with a floppy disk and a claim form and they were collected by a courier and driven to a government office in Parramatta or, in the case of my boss, Mr Drew, who did not trust couriers, they were driven by Mr Drew to Parramatta. Much has changed in the 20 years I have worked as a pharmacist, including real-time claiming through PBS Online and e-prescribing through e-prescription exchange, improving the safety and efficiency of the dispensing process. The outcome of these reforms should mean reduced payment times for pharmacists, and I welcome this. However, there is more work to be done. The integration of PBS records with general health recordsa genuinely integrated approachwould improve the efficiency and safety of prescribing and treatment and improve health outcomes for Australians.

This bill also aims to reduce the time doctors and authorised prescribers spend seeking approval to write authority prescriptions by phone or in writing. Pharmacists, however, do much more than fill prescriptions. They are the most accessible of all the health professionals. You do not need an appointment to see them; they are generally open later and longer; and there is no fee to seek your pharmacist's advice. Professional Pharmacists Australia, in their submission to the King review, describe a regular day for a community pharmacist as:

dispensing, counselling, writing medical certificates, fixing a patient's glucometer, demonstrating correct inhaler techniques, paperwork, calling doctors, preparing Webster Packs, performing medicine reviews and providing first aid advice. In addition to these health care services, many pharmacists are also expected to perform retail tasks, including home deliveries.

Having worked for more than a decade in a hospital pharmacy, where 20 per cent of PBS is expended, I would add to this list for hospital pharmacists: best possible medication histories on admission, clinical screening and intervention and collaboration with patients and carers as part of multidisciplinary teams to provide the best possible care.

Pharmacists in community and hospital settings put patients at the centrethey always put patients firstbut if the demands on their time are too great, the care they are able to provide is affected. According to Professional Pharmacists Australia:

Many pharmacists report heavy and unrealistic workloads which increases the pressure to dispense more quickly, along with a range of other professional and non-professional requirements, with the possibility of an increase in the chances of errors. This is against a backdrop of an increasing number of subsidised prescriptions from 208 million in 2011-12 to 223 million in 2013-14.

Governments can, and should, support the work of pharmacists as an integral part of the healthcare system and, while this bill presents an opportunity to gain small efficiencies in the administration of the PBS, there is more work to be done if we are serious about improving and strengthening the PBS.

Importantly, we should look closely at the sections of this bill that deal with safeguards, including the responsibility for decisions to remain with the minister, secretary and chief executive. There are also safeguards in place relating to reviews. But we know this is not without risk. Even a small input error or programming mistake could see thousands of wrong decisions. We need look no further than the Centrelink robo-debt debacle to see how a system can be completely bungled by this government. My office has been inundated with complaints from people who have received incorrect debt letters from Centrelink and who struggle to clear their name. They have done nothing wrong, but to prove that often takes hoursfrom seeking records from past employers to phone calls and visits to Centrelink offices. With a department so drastically under-resourced and directives from a government so callously opposed to the social safety net, this is not just a stuff upit is just cruel.

With close to 300 million prescriptions issued in the past year through thousands of PBS-approved suppliers and billions of dollars paid in subsidies each year, the government must ensure the rollout of these measures is done properly. But when we look at its record, we are right to have reservations about its ability or desire to properly manage this. This is the government that has incompetently managed e-health and has been dishonest about delays to the cervical and bowel cancer screening register. This is the government that bungled the census; it is the architect of the second-rate NBN and its patchwork of technologies. The government talks of innovation, agility and exciting times, but that is all it isjust talk. We will be watching the rollout of computerised decision making for PBS claims and approvals very closely. Please do not stuff this one up, too.

This bill represents minor but important changes to the operation of the PBS. These are just some of the pressing issues facing pharmacists, health workers and patients on the Central Coast. During recent conversations with local health practitioners and practice managers at my health roundtable, unfreezing Medicare rebates and updating the data used to determine Districts of Workforce Shortage were important ways to ensure fair and equitable access to health care. The government's own figures show more than 15,000 people on the Central Coast say they delay or avoid seeing a GP due to cost, and the Medicare freeze only makes this problem worse. I am alarmed that more than 30,000 people on the Central Coast say they delay or avoid filling prescriptions due to cost. This will only get worse if the plan to increase the cost of medicines by up to $5 a script goes ahead.

For those people experiencing financial hardship, increases in the cost of medicines can mean making the choice between filling a prescription or putting food on the table. Analysis by the Family Medicine Research Centre at the University of Sydney has shown that, although the increase in the co-payment is less for concessional patients, on average the actual cost increase for medications is higher. We know that this leads to disease progression, higher rates of hospital admissions and increased costs to the health system and the individual in the long term.

I was a pharmacist at Wyong Hospital for almost a decade and for the largest part of my career I was the specialist pharmacist in the inpatient mental health unit. I have seen the challenges that vulnerable people living in my community face first-hand. Coupled with a proposal from the New South Wales government to privatise Wyong Hospital, I am deeply concerned about the future health care for my local community. Last year, the federal government provided over $111 million in funding for the Central Coast Local Health District. The Prime Minister and the health minister have a direct stake in Wyong Hospital, and I call on them to step in and save Wyong Hospital.

Labor supports this bill and will continue to support commonsense changes that improve the efficient and effective delivery of healthcare services. But so too will we continue to hold this government to account as it embarks on a callous, ideologically-driven attack on Medicare and the PBS. We will do so because it is fundamental to the values of the Labor Party. The Labor Party is the party of Medicare, the party of the PBS and the party of universal health care.