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House of Assembly - Fifty-First Parliament, Third Session (51-3)
2008-09-25 Daily Xml
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COUNTRY DOMICILIARY CARE

Ms CHAPMAN (Bragg—Deputy Leader of the Opposition) (12:18): I move:

That this house condemns the government for increasing fees for domiciliary care type services provided by Country Health SA.

It is with pleasure that I move this motion. As if country people have not been abused enough in the attempt by the government to impose the ill-fated Country Health Care Plan, it proceeded, in July this year, to publish a statement of its reviewed provision for the use of domiciliary type care in country areas. This matter came to the attention of the opposition by way of a letter that had been sent to people in Port Pirie, which stated:

There has been changes recently to the eligibility criteria for a waiver to bring Country Health SA units into line with Domiciliary Care SA to ensure uniformity across South Australia.

That is another direct example of this government's inane idea that everyone across South Australia has some kind of equal, equitable access to health care services and, in particular, domiciliary type health care services. What a pea brain of an idea is that to start with—to suggest that the government will now bring domiciliary type care services, which are often provided and administered through local country hospitals, to the people in country communities (the more remote they are, the more isolated and costly it is to have access to them), and that has to match up in some way with the domiciliary care services that are now provided under the supervision of the Minister for Families and Communities.

That is another ridiculous idea from this government, which has a direct financial consequence on those who already have the extra costs of transport and accessibility to health services. The announcement was that the expenditure threshold for the fee waiver application would be increased from $76 per household per four week period to $96, a $20 increase. If that was not bad enough, they also announced that private health insurance costs are no longer a claimable expense in a fee waiver application. This is, of course, an indicator of how inhumane the government is in not recognising that the people who apply for these services are already in very impoverished circumstances. Adding $20 to the cost will, of course, have a direct consequence of excluding some people from a very necessary service.

The people who use these services are obviously sick, frequently aged and frail, and/or disabled. They certainly do not have access to the myriad services available in Adelaide. It is bad enough that they should have this imposed on them, but it is not surprising that the government would do this. It attempted to increase the rental fees of wheelchairs for disabled people earlier this year. Of course, that was condemned around the state and, ultimately, the then minister had to withdraw that idea, which I think identified a saving to government of $200,000—peanuts, in the scheme of things, but it would mean a lack of any kind of independence through access to wheelchair hire, the use of aids for the disabled, etc., It was a scandalously ill-conceived and, I think, an inhumane attempt. We know what form they have and we know what precedent they tried to introduce, so it does not surprise us that they do this.

The interesting aspect of this that I bring to the parliament's attention is that it is consistent with the Australian Labor Party's ideological hatred of private health insurance. Its blind obsession is to undermine the survival of independent health services in this country. I say that because to no longer make private health insurance costs a claimable expense in a fee waiver application has a direct consequence of undermining the viability of people maintaining health insurance—which many people do even though keeping it causes a sacrifice in their family budget. It results in a loss of access to any other discretionary money that they might use for holiday, some respite, an extra bit of food, a minor bit of entertainment or social activity, and those things are frequently sacrificed in these households to ensure the maintenance of private health insurance.

Bear in mind that people living in the country also often do not have access to public health services in country areas, let alone private health services. If they need to travel to Adelaide and receive immediate health care, to avoid the extra burden and cost of accommodation and staying in Adelaide, of course, they need to be able to maintain their private health insurance. So the argument is that, for people in remote or regional South Australia, it is even more important that they be encouraged to maintain health insurance.

We know again that this is the form of the Australian Labor Party. The federal health minister attempted to introduce a new regime in respect of the thresholds to which the Medicare levy surcharge would apply. Recently, the federal government and minister announced an increase in the threshold, which would again provide a major disincentive. Let me go back a stage. The 1 per cent levy is imposed for those people who do not take up private health insurance. In other words, if you do not do that, not only are you not eligible for the rebate that the previous federal government had introduced and which this government tried to get rid of (but, of course, had to step back on because it wanted to win office last year) but, also, the surcharge means that if you do not pay it you have another penalty, namely, an extra percentage of your tax is taken, again, as an incentive to get to you to be independent of the public health system. It is a very sensible policy, but Ms Roxon wanted to introduce a system of increasing that threshold. It is a backdoor way of undermining private health insurance.

Here is the interesting thing: as a result of research undertaken by the Catholic church, the AMA and private health insurers (to name but a few), they say that there would be a mass abandonment. For the state government and minister Hill not to have addressed this issue is bad enough—although, fortunately, last night in the Senate, this ridiculous idea was voted out—but minister Hill should not be carving off the benefits which are necessary to support people living in the country and which ensure that they have access to these important services. He should be telling his federal minister that she needs to understand that this type of ridiculous federal policy will overflow, balloon out and bust state budgets when it comes to the provision of public health cover.

The direct consequence of the research undertaken by the Catholic church, the AMA and the private health insurers is that hundreds of thousands of people will be forced to abandon private health insurance which will increase the burden on the public health sector. The Minister for Health, rather than introducing these ridiculous ideas, should be saying to the federal minister, 'We will not accept that, or, at the very least, if you want to impose this type of policy at the federal level, you pay for it', because it will have a direct consequence on the budget line of our state budget and the casualty will be the people of South Australia, the taxpayers, because either a much bigger slice of the state budget will need to be allocated to this and/or the state budget will need to expand for the purpose of funding it. Minister Hill should also say, 'You ensure, federal minister that, if you want to introduce these ridiculous ideas, you understand the consequences to state administrations.'

Instead of that, what does he do? He nitpicks and tries to make a buck out of the poorest and most vulnerable people in our community—the sick, the disabled and the poor—namely, people living in country and regional parts of South Australia. It is about time this state government understood the importance of the real issues out there, and that taking a few dollars from the poor and vulnerable is not the way to govern. They should be dealing with this issue at a national level, understanding the financial consequence of the millions of dollars that we will have to pick up in this state—in fact, state governments across Australia (and not just current state governments but subsequent governments)—and understanding that, as a result of their failure to deal with this matter, the casualties will be the people of South Australia who currently have no other option but to rely on the public health sector.

They are isolated from any other access to services. Usually, it is due to their impecunious state, but sometimes it is due to the isolation of the community in which they live or their special need which impedes them from being able to get access to that or even to make the decision to get it. They are already isolated and they are in desperate need, and their only available service is through the public health system. That will haemorrhage and be a casualty if this minister does not address that most important issue and not try to make a miserable buck out of some poor, disabled pensioner who is trying to live a reasonable life in his little country town—in this case, Port Pirie.

I urge the government to understand the real consequences of this to real people, the damage it is doing and its ultimate neglect and irresponsibility in failing to deal with the big issues.

Mr GRIFFITHS (Goyder) (12:29): It is my pleasure to contribute to the motion moved by the member for Bragg and to congratulate her on bringing it to the attention of the house. It is important that we in this place understand the pressure under which people in regional South Australia live. It has been my pleasure to have lived in regional areas for the absolute majority of my life. It has been my great pleasure to get to know the individuals who make up a community. We all come with different perspectives to our lives, but everyone is part of a community and they contribute in some way.

Importantly, the suggestion to increase fees for domiciliary care services provided in the regions is disappointing. These people have circumstances in their life that create a difficulty for them, but they are fiercely independent and want to retain their independence. They want to live in their home and community and to continue to contribute to their community, but they are fearful that it is becoming increasingly expensive to be part of it because there is difficulty getting the services they need in the town in which they live or they are too expensive for them.

These people make an enormous number of sacrifices. I meet them every day and, as we get around the electorate we serve, we meet people doing things tough and whose circumstances are difficult. That is why it is important that the philosophy of government, when determining policy and fee structure for services and when providing services to people, considers the effect on real people, people who are struggling. It is important that we have the belief that, when we put in place a process to give people a service, we provide it at a cost that is attractive to them.

Most of these people do not have large incomes, many have struggled most of their lives, raised large families, potentially lost a partner as they got older and are by themselves. Their immediate family may no longer be living close to them and they rely on friendships and relationships with neighbours and people in the town in which they live, but they want access to the types of services provided through so many different agencies.

The service that Country Health coordinates is important because people need domiciliary care. I know there are good programs that provide assistance to ensure people can remain in their homes for as long as possible, and that is a strong focus and policy of government at all levels, to encourage people to do that. The day will come when it is necessary for them to go into a care facility, but people who want to remain in their home and independent need services to do that, and it is important that structures are in place and dollars go into these programs to ensure they can be available at a reasonable cost.

There is no debate from the people I speak to that they expect to pay something for the service they receive, but it is important that the fees are structured in such a way that they are an option for people to take up and not something that is discretionary. It should not be a case of choosing to take up this service from domiciliary care or putting food on the table. No South Australian wants to live with that sort of pressure.

The fact that the member for Bragg has brought the issue before the house is important. Members on this side support her motion. Let us hope we get a change in thought so people can have confidence that the government they elect, of whatever political persuasion, makes the right decisions at all times to ensure that these people can continue to live in the communities that they have loved for many years.

Mr PEDERICK (Hammond) (12:33): I, too, support the motion moved by the member for Bragg and congratulate her and the member for Goyder on their comments. It seems that the government does not acknowledge the massive amount of money saved by people living in their own homes and not looking for places to live because services are currently supplied to people living in their own homes. It is entirely relevant that these care services are supplied by Country Health to keep people in their homes. My 88 year old father still lives in his home, and I hope he does for a while yet, but his health issues will need to be monitored.

When you live 150 kilometres from the centre of Adelaide, services whither away the further from the city centre you go, particularly when you have a city-centric administration that does not realise that things exist outside its mainly city-based electorates and we run into trouble. I acknowledge the services that have been supplied not just through Country Health but through some of the federally funded programs and non-government agencies that help people stay in their homes, which are to be commended.

Some of these services, including services provided by Country Health, need a full audit in order to see how much of the money that goes into funding these services actually hits the ground and how much is tied up in the bureaucracy running these vital functions for regional communities. They save the government hundreds of millions of dollars in aged-care facilities, whether they be independent living facilities, low-needs facilities or high-needs facilities. It saves that full continuum of service for as long as people can live in their own home.

As a result of my father's situation, things such as handrails and other facilities have been put into the house to ensure ease of access. It makes it so much easier when someone can be in their own home, especially in the country. Too many people from regional areas have been moved off for whatever reason—probably because of a lack of services—and gone into homes, and they shut down and end their days far quicker than they would if they were able to stay in their own home.

That is the crux of this motion. People will be priced out of being able to stay in their own home, where they want to be, and will have to go somewhere else, which in the longer term will cost the government hundreds of millions of dollars in the bigger scheme of things. I commend the motion of the member for Bragg; I think it is an excellent initiative.

Debate adjourned on motion of Mrs Geraghty.

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